Provider Demographics
NPI:1669926978
Name:BRINKE, TYFANAE (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:TYFANAE
Middle Name:
Last Name:BRINKE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 BRANFORD PL STE 102B
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-1018
Mailing Address - Country:US
Mailing Address - Phone:615-236-5815
Mailing Address - Fax:
Practice Address - Street 1:2095 BRANFORD PL STE 102B
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-1018
Practice Address - Country:US
Practice Address - Phone:907-795-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK114314363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine