Provider Demographics
NPI:1114585635
Name:JENKINS, LATORYA (CNA)
Entity Type:Individual
Prefix:
First Name:LATORYA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E MARKET RD
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-1701
Mailing Address - Country:US
Mailing Address - Phone:386-344-8949
Mailing Address - Fax:
Practice Address - Street 1:413 E MARKET RD
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-1701
Practice Address - Country:US
Practice Address - Phone:386-344-8949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1019927003747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty