Healthcare Provider Details

I. General information

NPI: 1235473307
Provider Name (Legal Business Name): TRAVIS B BRINKERHOFF NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR STE 2600
SAINT GEORGE UT
84790
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-2700
  • Fax: 435-656-4907
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5908242-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: