Provider Demographics
NPI:1912884818
Name:CARRASCO, TIM
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CHAPPELL
Mailing Address - State:NE
Mailing Address - Zip Code:69129-6930
Mailing Address - Country:US
Mailing Address - Phone:970-319-1359
Mailing Address - Fax:
Practice Address - Street 1:2770 11TH AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-9601
Practice Address - Country:US
Practice Address - Phone:308-254-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider