Provider Demographics
NPI:1336824820
Name:WHEATON, TIMOTHY HARRY (MSN-ED, RN)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:HARRY
Last Name:WHEATON
Suffix:
Gender:M
Credentials:MSN-ED, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5544 SILTSTONE ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-3171
Mailing Address - Country:US
Mailing Address - Phone:603-260-1219
Mailing Address - Fax:
Practice Address - Street 1:5544 SILTSTONE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-3171
Practice Address - Country:US
Practice Address - Phone:603-260-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
FL9588368163WP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health