Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Timothy B Different, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1730643032

Timothy B Different, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Jacksonville, Texas. Qualified in 2018, 8 years ago. Practices with Lake Granbury Hospital-Based Professional Services, a 72-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
8
Licensed in
TX
In the registry since
2019
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

2026 S Jackson St
Jacksonville, TX 75766-5822
Phone: (903) 586-5678
Fax: (903) 541-4679
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence AP140173 (TX)

Record details

NPI number1730643032
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedJanuary 31, 2019
Last updated in NPPESMay 21, 2019
Mailing addressPo Box 847522, Dallas, TX 75284-7522

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Lake Granbury Hospital-Based Professional Services — 72 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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