Provider Demographics
NPI:1487314167
Name:QUICK, TYMBER
Entity type:Individual
Prefix:
First Name:TYMBER
Middle Name:
Last Name:QUICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4553 WATKINS ST
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2511
Mailing Address - Country:US
Mailing Address - Phone:850-800-9772
Mailing Address - Fax:
Practice Address - Street 1:4553 WATKINS ST
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-2511
Practice Address - Country:US
Practice Address - Phone:850-800-9772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5249240164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse