Provider Demographics
NPI:1205263019
Name:MORRILL, TIMOTHY DAVID (ARNP, CAP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:MORRILL
Suffix:
Gender:M
Credentials:ARNP, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 GOLF RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1224
Mailing Address - Country:US
Mailing Address - Phone:847-563-4488
Mailing Address - Fax:847-770-4484
Practice Address - Street 1:4711 GOLF RD STE 1200
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1200
Practice Address - Country:US
Practice Address - Phone:847-563-4488
Practice Address - Fax:847-770-4484
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9343749163WA0400X
IL309012055363LA2200X, 363LP0808X
FLARNP9343749363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021671900Medicaid