Provider Demographics
NPI:1548342496
Name:TIMM, TONI K (FNP)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:K
Last Name:TIMM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:K
Other - Last Name:TIMM-WINNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:45-602 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2017
Mailing Address - Country:US
Mailing Address - Phone:808-432-3800
Mailing Address - Fax:
Practice Address - Street 1:45-602 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2017
Practice Address - Country:US
Practice Address - Phone:808-432-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-48363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000219923OtherHMSA BILLING NUMBER
HI54951101Medicaid
HIP01376Medicare UPIN
HI54951101Medicaid