Healthcare Provider Details

I. General information

NPI: 1134797731
Provider Name (Legal Business Name): TAYLOR TENBRINK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S 8TH ST STE 301
GRIFFIN GA
30224-4260
US

IV. Provider business mailing address

1773 FUTRAL RD
GRIFFIN GA
30224-7838
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-6072
  • Fax:
Mailing address:
  • Phone: 705-841-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN170622
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: