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Individual
TIMOTHY WAYNE PACE
Active
Individual
TIMOTHY WAYNE PACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1939
NE
363A00000X
Physician Assistant
Primary
PA23139
CA
363A00000X
Physician Assistant
PA9104343
FL
363AS0400X
Surgical Physician Assistant
PA1385
ME
363AS0400X
Surgical Physician Assistant
PA644
AL
363AS0400X
Surgical Physician Assistant
PA9104343
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102978408
MEDICARE PTAN
AL
05
—
262936800
—
FL
Enumeration date
11/15/2007
Last updated
12/11/2024
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