Provider Demographics
NPI:1285657726
Name:O'LEARY, TIMOTHY E (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:O'LEARY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 GLENBROOK WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1231
Mailing Address - Country:US
Mailing Address - Phone:615-590-2020
Mailing Address - Fax:
Practice Address - Street 1:1047 GLENBROOK WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1231
Practice Address - Country:US
Practice Address - Phone:615-590-2020
Practice Address - Fax:615-590-2027
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1088363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P99829Medicare UPIN