Provider Demographics
NPI:1861018988
Name:TERRELL, TYMBER TATUM (APRN)
Entity type:Individual
Prefix:
First Name:TYMBER
Middle Name:TATUM
Last Name:TERRELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TYMBER
Other - Middle Name:LEE
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4289 NW AMERICAN LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4881
Mailing Address - Country:US
Mailing Address - Phone:386-628-8008
Mailing Address - Fax:386-200-5755
Practice Address - Street 1:4289 NW AMERICAN LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4881
Practice Address - Country:US
Practice Address - Phone:386-628-8008
Practice Address - Fax:386-200-5755
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007399363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1861018988OtherPROVIDER TYPE 1 NPI
FLAPRN11007399OtherLICENSE