Timothy Anderson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 908641 Issued in FL

Practice address

954 Lake Baldwin LN
Orlando, FL 32814-6651

Phone

(407) 478-9797

Fax

(407) 478-9798

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: timothy.anderson@761290127507460.direct.elationemr.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470700800000",
    "number": "1063496222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "954 LAKE BALDWIN LN",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328146651",
            "telephone_number": "407-478-9797",
            "fax_number": "407-478-9798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 LAKE BALDWIN LN",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328146651",
            "telephone_number": "407-478-9797",
            "fax_number": "407-478-9798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "TIMOTHY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2016-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03747",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 908641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Anderson
• Seth Anderson, PA-C
• Stacyann Nadine Anderson
• Tanner Anderson, MS, BCBA
• Tiffany Harrison Anderson, LCSW
• Timothy Joseph Anderson, DNP, APRN, ACPNC-AG
• Vanetta Anderson, ARNP
• Vera O Anderson, ARNP
• William T. Anderson, D.M.D., M.S.
• Selina Andersson I

• Physician Assistant in Orlando, FL
• Providers in Orlando, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.