Provider Demographics
NPI:1831271840
Name:BOHAN, TIMOTHY PATRICK (NP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:BOHAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 E PIMA STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5601
Mailing Address - Country:US
Mailing Address - Phone:520-382-2819
Mailing Address - Fax:520-382-2832
Practice Address - Street 1:5700 E PIMA STREET
Practice Address - Street 2:SUITE B
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-324-1922
Practice Address - Fax:520-324-1088
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1294363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ569212-02Medicaid
AZ569212OtherAHCCCS
Z70498Medicare ID - Type Unspecified
AZ569212-02Medicaid