Healthcare Provider Details

I. General information

NPI: 1811450430
Provider Name (Legal Business Name): JEREMY ZINKE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S 13TH AVE
ALPENA MI
49707-1609
US

IV. Provider business mailing address

538 W WOODWARD AVE
ROGERS CITY MI
49779-2054
US

V. Phone/Fax

Practice location:
  • Phone: 989-944-4420
  • Fax:
Mailing address:
  • Phone: 989-944-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704310633
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: