Provider Demographics
NPI:1255343505
Name:HOVLAND, TIMOTHY OLE (PA-C)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:OLE
Last Name:HOVLAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 SAMARITAN DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4008
Mailing Address - Country:US
Mailing Address - Phone:408-358-8300
Mailing Address - Fax:408-358-8301
Practice Address - Street 1:2505 SAMARITAN DR STE 210
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4008
Practice Address - Country:US
Practice Address - Phone:408-358-8300
Practice Address - Fax:408-358-8301
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12929363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01378879OtherRAILROAD MEDICARE PTAN
CAP01378879OtherRAILROAD MEDICARE PTAN
CADE384ZMedicare Oscar/Certification
CAR23477Medicare UPIN