Provider Demographics
NPI:1538606546
Name:TIMMRECK, DAYNA RAE-EDGERTON (FNP-BC)
Entity type:Individual
Prefix:
First Name:DAYNA
Middle Name:RAE-EDGERTON
Last Name:TIMMRECK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 FLECKENSTEIN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3042
Mailing Address - Country:US
Mailing Address - Phone:810-877-7370
Mailing Address - Fax:810-230-9338
Practice Address - Street 1:3400 FLECKENSTEIN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3042
Practice Address - Country:US
Practice Address - Phone:810-877-7370
Practice Address - Fax:810-230-9338
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-28
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704280706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily