Individual
TIMOTHY A WALLNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
38035 MEDICAL CENTER AVE, ZEPHYRHILLS, FL 33540-1384
(813) 788-1400
(813) 788-7691
Mailing address
PO BOX 2709, ZEPHYRHILLS, FL 33539-2709
(813) 788-1400
(813) 788-7691
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0003396
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9104784
FL LICENSE
FL
Enumeration date
10/11/2006
Last updated
11/04/2014
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