Provider Demographics
NPI:1336824820
Name:WHEATON, TIMOTHY HARRY (MSN-ED, APRN PMHNP-B)
Entity type:Individual
Prefix:PROF
First Name:TIMOTHY
Middle Name:HARRY
Last Name:WHEATON
Suffix:
Gender:M
Credentials:MSN-ED, APRN PMHNP-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3852 INDIAN RIVER CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-1886
Mailing Address - Country:US
Mailing Address - Phone:863-316-5446
Mailing Address - Fax:
Practice Address - Street 1:3852 INDIAN RIVER CT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-1886
Practice Address - Country:US
Practice Address - Phone:863-316-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9588368163WP0808X, 163W00000X
101YP1600X
FLAPRN11043704363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No163W00000XNursing Service ProvidersRegistered Nurse