Provider Demographics
NPI:1871826958
Name:IRIZARRY, TIMOTHY NEAL (PA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:NEAL
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11415 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4489
Mailing Address - Country:US
Mailing Address - Phone:501-224-5220
Mailing Address - Fax:501-228-9828
Practice Address - Street 1:11415 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4489
Practice Address - Country:US
Practice Address - Phone:501-224-5220
Practice Address - Fax:501-228-7095
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPA-380363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant