Provider Demographics
NPI:1184867889
Name:SAVAGE-EASTBURN, TIMOTHY (PA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:SAVAGE-EASTBURN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 NW 43RD ST
Mailing Address - Street 2:SUITE 102 #387
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4484
Mailing Address - Country:US
Mailing Address - Phone:352-328-1529
Mailing Address - Fax:352-548-4801
Practice Address - Street 1:1311 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1128
Practice Address - Country:US
Practice Address - Phone:352-376-8821
Practice Address - Fax:352-277-7606
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3438363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical