Provider Demographics
NPI:1467104901
Name:TIMS, MERIAH FAITH
Entity Type:Individual
Prefix:
First Name:MERIAH
Middle Name:FAITH
Last Name:TIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4761
Mailing Address - Country:US
Mailing Address - Phone:561-548-2662
Mailing Address - Fax:561-548-1633
Practice Address - Street 1:4685 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-4761
Practice Address - Country:US
Practice Address - Phone:561-548-2662
Practice Address - Fax:561-548-1633
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017692364SF0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health