MEDICARE: TIMOTHY MICHAEL COOKERLY FNP-BC

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	363LF0000X	Family Nurse Practitioner	95232157	CA

General Provider Information

NPI Number	:	1881559409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY MICHAEL COOKERLY FNP-BC

Provider Business Mailing Address
First Line	:	72140 MAGNESIA FALLS DR STE 1
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-4941
Country	:	US
Telephone Number	:	760-699-7607
Fax Number	:	760-699-7864

Provider Business Practice Location Address
First Line	:	72140 MAGNESIA FALLS DR STE 1
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-4941
Country	:	US
Telephone Number	:	760-699-7607
Fax Number	:	760-699-7864

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

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	05/29/2026

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