Provider Demographics
NPI:1952890782
Name:BRINZA, TAMERA (MA, AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:BRINZA
Suffix:
Gender:F
Credentials:MA, AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 E 106TH ST APT 10204
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3135
Mailing Address - Country:US
Mailing Address - Phone:317-507-6252
Mailing Address - Fax:
Practice Address - Street 1:2102 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4369
Practice Address - Country:US
Practice Address - Phone:765-643-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001563A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist