Provider Demographics
NPI:1285120048
Name:WEAVER, TIMOTHY C (APRN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:WEAVER
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 1:360 N IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2808
Mailing Address - Country:US
Mailing Address - Phone:843-667-9414
Mailing Address - Fax:
Practice Address - Street 1:3380 PINE NEEDLES RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7908
Practice Address - Country:US
Practice Address - Phone:843-432-2952
Practice Address - Fax:843-799-1959
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily