Provider Demographics
NPI:1518363282
Name:JENKINS, KRISTEN W (APRN-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:W
Last Name:JENKINS
Suffix:
Gender:F
Credentials:APRN-C
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Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-396-4893
Practice Address - Street 1:2532 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4424
Practice Address - Country:US
Practice Address - Phone:850-900-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9393630363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014250600Medicaid
FLY0PQ9OtherFLORIDA BLUE
GA054295568OtherDRIVERS LICENCE