Provider Demographics
NPI:1346740420
Name:ZINKE, ANDREA D (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:D
Last Name:ZINKE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24901 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1367
Mailing Address - Country:US
Mailing Address - Phone:586-772-9055
Mailing Address - Fax:586-772-0543
Practice Address - Street 1:24901 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1367
Practice Address - Country:US
Practice Address - Phone:586-772-9055
Practice Address - Fax:586-772-0543
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704214711363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner