Provider Demographics
NPI:1629509922
Name:BRINK, AMY LYNN (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BRINK
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 NORTHDALE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1800
Mailing Address - Country:US
Mailing Address - Phone:813-570-6971
Mailing Address - Fax:
Practice Address - Street 1:3910 NORTHDALE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1800
Practice Address - Country:US
Practice Address - Phone:813-570-6971
Practice Address - Fax:813-570-6977
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16781208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLXM1QOtherBCBS
FL106450400Medicaid