Provider Demographics
NPI:1932726122
Name:BYRD, TIMOTHY (APRN)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:BYRD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 23RD ST N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2882
Mailing Address - Country:US
Mailing Address - Phone:904-525-6188
Mailing Address - Fax:904-247-6431
Practice Address - Street 1:1175 23RD ST N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2882
Practice Address - Country:US
Practice Address - Phone:904-525-6188
Practice Address - Fax:904-247-6431
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007181363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily