Provider Demographics
NPI:1376031732
Name:TIMPSON, MIGINA ANICA (APRN)
Entity Type:Individual
Prefix:
First Name:MIGINA
Middle Name:ANICA
Last Name:TIMPSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RIVERBED DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-6425
Mailing Address - Country:US
Mailing Address - Phone:864-346-3369
Mailing Address - Fax:
Practice Address - Street 1:317 SAINT FRANCIS DR STE 220
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3976
Practice Address - Country:US
Practice Address - Phone:864-255-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21858363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health