Provider Demographics
NPI:1982790242
Name:TINKLER, JENNIFER A (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:TINKLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 24TH ST NW STE 110
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6380
Mailing Address - Country:US
Mailing Address - Phone:218-444-3998
Mailing Address - Fax:218-444-2939
Practice Address - Street 1:2300 24TH ST NW STE 110
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6380
Practice Address - Country:US
Practice Address - Phone:218-444-3998
Practice Address - Fax:218-444-2939
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR124325-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNQ39709Medicare UPIN
ND17915Medicare PIN