Healthcare Provider Details

I. General information

NPI: 1174903637
Provider Name (Legal Business Name): JENNIFER L BRINKMAN MSN, APRN, AGCNS-BC,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2015
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE MAIL CODE S1-15
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE MAIL CODE S1-15
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-0813
  • Fax:
Mailing address:
  • Phone: 216-445-0813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number17359
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: