Provider Demographics
NPI:1912324252
Name:KAMINSKI, TIMOTHY (MSN, CNP-BC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:MSN, CNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 STARR AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2456
Mailing Address - Country:US
Mailing Address - Phone:419-936-7801
Mailing Address - Fax:419-936-7606
Practice Address - Street 1:1425 STARR AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2456
Practice Address - Country:US
Practice Address - Phone:419-936-7801
Practice Address - Fax:419-936-7606
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN362272163WP0808X
OHAPRNCNP020963363LG0600X
OH020963363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0183446Medicaid