Provider Demographics
NPI:1669109930
Name:ADAMS, TIMBERLIE JEANE (RN)
Entity type:Individual
Prefix:
First Name:TIMBERLIE
Middle Name:JEANE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TIMBERLIE
Other - Middle Name:S
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:149 KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-8933
Mailing Address - Country:US
Mailing Address - Phone:352-661-6409
Mailing Address - Fax:
Practice Address - Street 1:5050 COUNTRY RD 472
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484
Practice Address - Country:US
Practice Address - Phone:352-689-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV42175163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice