Provider Demographics
NPI:1477565570
Name:ZEOLIA, TIMOTHY R (PA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:ZEOLIA
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 1:6419 BRISTOL HWY
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-5208
Mailing Address - Country:US
Mailing Address - Phone:423-538-5202
Mailing Address - Fax:423-538-8208
Practice Address - Street 1:6419 BRISTOL HWY
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-5208
Practice Address - Country:US
Practice Address - Phone:423-538-5202
Practice Address - Fax:423-538-8208
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505553Medicaid
TNP01418134OtherRR MDCR
TN103I971332Medicare PIN
TN1505553Medicaid
TN103I9976131Medicare PIN
TN3664632Medicare PIN
TN379285Medicare UPIN