Provider Demographics
NPI:1811450430
Name:ZINKE, JEREMY (FNP)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:ZINKE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 W WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-2054
Mailing Address - Country:US
Mailing Address - Phone:989-944-4420
Mailing Address - Fax:
Practice Address - Street 1:109 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1609
Practice Address - Country:US
Practice Address - Phone:989-944-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704310633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily