Healthcare Provider Details

I. General information

NPI: 1285894766
Provider Name (Legal Business Name): TAMIKA LASHAWN BRINSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PINEVILLE REHABILITATION & LIVING CENTER 1010 LAKEVIEW DR
PINEVILLE NC
28134
US

IV. Provider business mailing address

4228 AMBER LEIGH WAY DR
CHARLOTTE NC
28269-2341
US

V. Phone/Fax

Practice location:
  • Phone: 704-889-2273
  • Fax:
Mailing address:
  • Phone: 585-300-1504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number587851
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5020749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: