Provider Demographics
NPI:1245843184
Name:PEACE, TIMOTHY RAY JR (MSN, CRNP, FNP-C)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RAY
Last Name:PEACE
Suffix:JR
Gender:M
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LEET ST
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8736
Mailing Address - Country:US
Mailing Address - Phone:724-681-9729
Mailing Address - Fax:
Practice Address - Street 1:422 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2405
Practice Address - Country:US
Practice Address - Phone:724-318-8793
Practice Address - Fax:724-385-0278
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily