Basic Information
| Provider Information | |||||||||
| NPI: | 1134797731 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TENBRINK | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1773 FUTRAL RD | ||||||||
| Address2: | |||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302247838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7058410557 | ||||||||
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| Practice Location | |||||||||
| Address1: | 619 S 8TH ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302244260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702296072 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2021 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN170622 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.