Provider Demographics
NPI:1144370032
Name:CRUICKSHANK, TIMOTHY VALENTINE (PA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:VALENTINE
Last Name:CRUICKSHANK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MADISON ST STE 701
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2099
Mailing Address - Country:US
Mailing Address - Phone:206-707-9299
Mailing Address - Fax:206-432-4552
Practice Address - Street 1:805 MADISON ST STE 701
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2099
Practice Address - Country:US
Practice Address - Phone:206-707-9299
Practice Address - Fax:206-432-4552
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10535560363A00000X
WA60705908363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant