Provider Demographics
NPI:1548782592
Name:TM MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:TM MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, CAP
Authorized Official - Phone:813-362-6816
Mailing Address - Street 1:11217 LONGBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7079
Mailing Address - Country:US
Mailing Address - Phone:813-362-6816
Mailing Address - Fax:
Practice Address - Street 1:131 N MOON AVE STE 3&4
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4418
Practice Address - Country:US
Practice Address - Phone:813-315-9898
Practice Address - Fax:813-438-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9343749363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty