Provider Demographics
NPI:1194469684
Name:STILES, TIMOTHY CARL (DME SUPPLIER)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CARL
Last Name:STILES
Suffix:
Gender:M
Credentials:DME SUPPLIER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6022 ATLANTIC BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-7503
Mailing Address - Country:US
Mailing Address - Phone:904-722-1882
Mailing Address - Fax:904-726-0730
Practice Address - Street 1:6022 ATLANTIC BLVD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-7503
Practice Address - Country:US
Practice Address - Phone:904-722-1882
Practice Address - Fax:904-726-0730
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies