Provider Demographics
NPI:1730947953
Name:JIMISON, TIMOTHY JORDAN (AG-ACNP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JORDAN
Last Name:JIMISON
Suffix:
Gender:M
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 PERIMETER HILL DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4123
Mailing Address - Country:US
Mailing Address - Phone:615-866-9040
Mailing Address - Fax:615-750-5756
Practice Address - Street 1:2004 HAYES ST STE 655
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2656
Practice Address - Country:US
Practice Address - Phone:615-866-9040
Practice Address - Fax:615-750-5756
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35906363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner