Provider Demographics
NPI:1447987110
Name:TIMOTHY FORD APRN, PLLC
Entity type:Organization
Organization Name:TIMOTHY FORD APRN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:SERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-990-8779
Mailing Address - Street 1:6756 STONYKIRK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:210-616-2204
Practice Address - Street 1:700 S ZARZAMORA ST STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5249
Practice Address - Country:US
Practice Address - Phone:210-998-2240
Practice Address - Fax:210-616-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty