Provider Demographics
NPI:1437744646
Name:JENKINS, JOANIE RACQUEL (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOANIE
Middle Name:RACQUEL
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JOANIE
Other - Middle Name:RACQUEL
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:28 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2709
Mailing Address - Country:US
Mailing Address - Phone:973-626-2274
Mailing Address - Fax:
Practice Address - Street 1:28 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2709
Practice Address - Country:US
Practice Address - Phone:973-626-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHPO302800163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty