MEDICARE: MERIAH FAITH TIMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SF0001X	Family Health Clinical Nurse Specialist	11017692	FL
2	363LF0000X	Family Nurse Practitioner	11017692	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467104901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERIAH FAITH TIMS

Provider Business Mailing Address
First Line	:	4685 S CONGRESS AVE
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-4761
Country	:	US
Telephone Number	:	561-548-2662
Fax Number	:	561-548-1633

Provider Business Practice Location Address
First Line	:	4685 S CONGRESS AVE
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-4761
Country	:	US
Telephone Number	:	561-548-2662
Fax Number	:	561-548-1633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	05/25/2023

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Directions to “ MERIAH FAITH TIMS ” Practice Location

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