Provider Demographics
NPI:1073170346
Name:JENKINS, TONYA LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LYNN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:TONYA
Other - Middle Name:LYNN
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:10 CENTER DRIVE 3NE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-450-0440
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DRIVE 3NE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-450-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1975051363LF0000X
MDR197051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily