Provider Demographics
NPI:1023438926
Name:DALIMATA, TIMOTHY JOHN (FNP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:DALIMATA
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 1:14470 HORIZON BLVD STE H
Mailing Address - Street 2:ATTN: JUDITH COSME
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7696
Mailing Address - Country:US
Mailing Address - Phone:915-217-2117
Mailing Address - Fax:915-217-1105
Practice Address - Street 1:14470 HORIZON BLVD STE H
Practice Address - Street 2:ATTN: JUDITH COSME
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-7696
Practice Address - Country:US
Practice Address - Phone:915-217-2117
Practice Address - Fax:915-217-1105
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX773496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily