Provider Demographics
NPI:1801615034
Name:BRINKMAN, TAMARA SUE
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:SUE
Last Name:BRINKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TAMI
Other - Middle Name:S
Other - Last Name:BRINKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9590 W POLK RD
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:MI
Mailing Address - Zip Code:49421-9625
Mailing Address - Country:US
Mailing Address - Phone:231-250-9654
Mailing Address - Fax:
Practice Address - Street 1:9590 W POLK RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:MI
Practice Address - Zip Code:49421-9625
Practice Address - Country:US
Practice Address - Phone:231-250-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X, 133NN1002X, 253Z00000X, 347C00000X
MI802422531374U00000X, 253Z00000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No374J00000XNursing Service Related ProvidersDoula
No253Z00000XAgenciesIn Home Supportive Care
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No347C00000XTransportation ServicesPrivate Vehicle