# TIMOTHY JOHN CRISCUOLO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1881613032
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 0110002020 | VA | — |
| 363A00000X | Physician Assistant | PA228610 | OR | — |
| 363A00000X | Physician Assistant | PA60921551 | WA | Yes |
| 363AM0700X | Medical Physician Assistant | PA60921551 | WA | — |

## Other

- **Enumeration date:** 07/19/2006
- **Last updated:** 03/23/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0110002020 | PHYSICIAN ASST LICENSE | VA |
| 05 | — | 1881613032 | — | VA |
| 05 | — | 2125665 | — | WA |