Provider Demographics
NPI:1053718197
Name:FORD, TIMOTHY (FNP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:210-990-8779
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:210-616-2204
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350729502Medicaid
TX350729503OtherCSHCN