Provider Demographics
NPI:1396923199
Name:TOBITT, TIMOTHY D (DPH, FNP-C, CEO)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:D
Last Name:TOBITT
Suffix:
Gender:M
Credentials:DPH, FNP-C, CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 E BROAD ST
Mailing Address - Street 2:GOOD HEALTH FMAILY CLINIC, INC.
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166
Mailing Address - Country:US
Mailing Address - Phone:615-597-4432
Mailing Address - Fax:615-597-4434
Practice Address - Street 1:414 E BROAD ST
Practice Address - Street 2:GOOD HEALTH FMAILY CLINIC, INC.
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166
Practice Address - Country:US
Practice Address - Phone:615-597-4432
Practice Address - Fax:615-597-4434
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33420181Medicaid
TN3342018Medicare PIN