Provider Demographics
NPI:1871787184
Name:TINKER, JEFFERY A (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:A
Last Name:TINKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 OLD LEBANON DIRT RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2386
Mailing Address - Country:US
Mailing Address - Phone:615-391-4545
Mailing Address - Fax:615-391-4546
Practice Address - Street 1:302 OLD LEBANON DIRT RD STE 200
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2391
Practice Address - Country:US
Practice Address - Phone:615-391-4545
Practice Address - Fax:615-391-4546
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000001086363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000723Medicaid
TNQ000723Medicaid
TN103I977157Medicare PIN