Individual
TIMOTHY M SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1800 N CAPITOL AVE, NP E-140, INDIANAPOLIS, IN 46202-1218
(317) 962-2894
(317) 963-5285
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71004054A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71004054A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201122680
—
IN
Enumeration date
08/08/2012
Last updated
02/16/2025
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