Provider Demographics
NPI:1346022076
Name:TIMMER, GARY LOUIS (DNP PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LOUIS
Last Name:TIMMER
Suffix:
Gender:
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 1:815 MONTCLAIRE CT
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2501 E COMMERCIAL SERVICES LLC
Practice Address - Street 2:SUITE 212
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3330
Practice Address - Country:US
Practice Address - Phone:954-990-6180
Practice Address - Fax:954-990-0173
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028906363LP0808X
FL11028906363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health