Individual
TIMOTHY PINETREE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP
Contact information
Practice address
3434 HANCOCK BRIDGE PKWY STE 309, NORTH FORT MYERS, FL 33903-7099
(855) 674-8800
(239) 599-4126
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774
(239) 599-2612
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN3307382
FL
363LA2200X
Adult Health Nurse Practitioner
COA.14394-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104893800
—
FL
01
—
LD356
MEDICARE
FL
01
—
YC9Q0
BCBS
FL
Enumeration date
04/16/2013
Last updated
08/26/2020
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