MEDICARE: IYANNA TIM RN

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	163W00000X	Registered Nurse	RN9549448	FL

General Provider Information

NPI Number	:	1821982141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IYANNA TIM RN

Provider Business Mailing Address
First Line	:	1045 55TH AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-5013
Country	:	US
Telephone Number	:	727-510-1171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 55TH AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-5013
Country	:	US
Telephone Number	:	727-510-1171
Fax Number	:

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

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	06/03/2025

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