Provider Demographics
NPI:1376262238
Name:WALKER, JINKY JIREH LOMONGO (RN)
Entity Type:Individual
Prefix:
First Name:JINKY JIREH
Middle Name:LOMONGO
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 SONG BIRD LAKES DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-9314
Mailing Address - Country:US
Mailing Address - Phone:904-508-4999
Mailing Address - Fax:
Practice Address - Street 1:350 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2874
Practice Address - Country:US
Practice Address - Phone:904-224-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9286116163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8411Other8411