Active NPI
Timothy Doral Robertson
- Dental Hygienist
- Jacksonville, FL
National Provider Identifier
1215674049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- DH21341
- Practice address
- 1536 N Jefferson St
Jacksonville, FL 32209-6525 - Phone
- (904) 475-6230
- NPI assigned
- May 13, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH21341 | FL | Primary |
Addresses
Primary practice location
1536 N Jefferson St
Jacksonville, FL 32209-6525
Mailing address
2750 Copperwood Ave
Orange Park, FL 32073-1686
Phone (904) 239-6721
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DH21341 | FL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652400000000",
"number": "1215674049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2750 COPPERWOOD AVE",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320731686",
"telephone_number": "904-239-6721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1536 N JEFFERSON ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322096525",
"telephone_number": "904-475-6230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "TIMOTHY",
"middle_name": "DORAL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-13",
"last_updated": "2022-05-13",
"certification_date": "2022-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "FL",
"license": "DH21341",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.