Provider Demographics
NPI:1386818052
Name:JENKINS, STEFANI DAWN
Entity Type:Individual
Prefix:MS
First Name:STEFANI
Middle Name:DAWN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3163 CONVERSE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-4110
Mailing Address - Country:US
Mailing Address - Phone:352-346-6611
Mailing Address - Fax:352-835-4333
Practice Address - Street 1:3163 CONVERSE AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-4110
Practice Address - Country:US
Practice Address - Phone:352-346-6611
Practice Address - Fax:352-835-4333
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker