MEDICARE: TYRONE DAKOTA BRININGER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.006711	OH

General Provider Information

NPI Number	:	1689271090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRONE DAKOTA BRININGER PA

Provider Business Mailing Address
First Line	:	184 ERIEVIEW DR
Second Line	:
City	:	EASTLAKE
State	:	OH
Zip	:	44095-1120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3609 PARK EAST DR STE 207
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44122-4309
Country	:	US
Telephone Number	:	216-360-0456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	05/24/2021

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