Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP1898582 | FL |
NPI | 1003862277 |
---|---|
Provider Name | Timothy Michael Faber |
First Address | Tampa, FL 33637-0913 |
Second Address | Tampa, FL 33613-4613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P72832 | (02) |