Provider Demographics
NPI:1629578703
Name:AMBORSKI, TIMOTHY (NP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:AMBORSKI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 M 139
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-3881
Mailing Address - Country:US
Mailing Address - Phone:855-869-6900
Mailing Address - Fax:269-927-4208
Practice Address - Street 1:800 M 139
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3881
Practice Address - Country:US
Practice Address - Phone:855-869-6900
Practice Address - Fax:269-927-4208
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244236363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner