Provider Demographics
NPI:1083693733
Name:BRINCK, TERRI L (ARNP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:BRINCK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:L
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5515 UTICA RIDGE RD
Mailing Address - Street 2:STE 600
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3928
Mailing Address - Country:US
Mailing Address - Phone:563-344-1050
Mailing Address - Fax:
Practice Address - Street 1:903 OAK ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-4608
Practice Address - Country:US
Practice Address - Phone:319-758-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-074743363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA220438OtherIOWA HEALTH SOLUTIONS
IA41396OtherWELLMARK
IAP-26533Medicare UPIN
IAI4385Medicare ID - Type Unspecified