Provider Demographics
NPI:1922018167
Name:VANWINKLE, TIMOTHY ERIC (NP)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ERIC
Last Name:VANWINKLE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:TIMOTHY
Other - Middle Name:ERIC
Other - Last Name:VAN WINKLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1747 IMPERIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1747 IMPERIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5362
Practice Address - Country:US
Practice Address - Phone:337-721-7236
Practice Address - Fax:337-721-7237
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN84018163WX0800X
LA221156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA221156OtherMEDICAL LICENSE
LARN84018OtherSTATE LICENSE #