Individual
TIMOTHY JOHN CRISCUOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1950 NW MYHRE RD FL 3, SILVERDALE, WA 98383-7662
(564) 240-4200
(564) 240-4299
Mailing address
1950 NW MYHRE RD FL 3, SILVERDALE, WA 98383-7662
(564) 240-4200
(564) 240-4299
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110002020
VA
363A00000X
Physician Assistant
PA228610
OR
363A00000X
Physician Assistant
Primary
PA60921551
WA
363AM0700X
Medical Physician Assistant
PA60921551
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110002020
PHYSICIAN ASST LICENSE
VA
05
—
1881613032
—
VA
05
—
2125665
—
WA
Enumeration date
07/19/2006
Last updated
03/23/2026
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