Provider Demographics
NPI:1093715971
Name:MEZZLES, JENINE BRINKMANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENINE
Middle Name:BRINKMANN
Last Name:MEZZLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:561-570-5172
Mailing Address - Fax:786-472-5770
Practice Address - Street 1:1314 GUADALUPE ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5582
Practice Address - Country:US
Practice Address - Phone:109-371-5971
Practice Address - Fax:210-686-3831
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA 00638363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA00638OtherLISCENCE NUMBER
TXPA00638OtherLISCENCE NUMBER
TXS33877Medicare UPIN