Provider Demographics
NPI:1154153237
Name:ROGERS, TIMOTHY (APRN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 BURR OAK CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6113
Mailing Address - Country:US
Mailing Address - Phone:941-350-5284
Mailing Address - Fax:
Practice Address - Street 1:2506 BURR OAK CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6113
Practice Address - Country:US
Practice Address - Phone:941-350-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily