Provider Demographics
NPI:1083379739
Name:ALTIZER, TIMOTHY WILLIAM (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:ALTIZER
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 CUKELA AVE
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-1434
Mailing Address - Country:US
Mailing Address - Phone:757-695-0112
Mailing Address - Fax:
Practice Address - Street 1:4389 BEAUFORT ROAD
Practice Address - Street 2:
Practice Address - City:CHERRY POINT
Practice Address - State:NC
Practice Address - Zip Code:28533
Practice Address - Country:US
Practice Address - Phone:252-466-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLAPRN11034040363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program