Provider Demographics
NPI:1154839397
Name:WHITE, TIMOTHY LEMERRILL (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEMERRILL
Last Name:WHITE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9982 SW 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-6089
Mailing Address - Country:US
Mailing Address - Phone:352-363-4256
Mailing Address - Fax:
Practice Address - Street 1:9982 SW 101ST AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-6089
Practice Address - Country:US
Practice Address - Phone:352-363-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL117539367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered