Provider Demographics
NPI:1215480512
Name:TIMBERLAKE, COURTNEY (NP-C)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:TIMBERLAKE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NORTH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1925
Mailing Address - Country:US
Mailing Address - Phone:330-633-3883
Mailing Address - Fax:
Practice Address - Street 1:33 NORTH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1925
Practice Address - Country:US
Practice Address - Phone:330-633-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily