Provider Demographics
NPI:1568918878
Name:JENKINS, TRACEY JOLENE (FNP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:JOLENE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 SHALLOWFORD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7222
Mailing Address - Country:US
Mailing Address - Phone:423-664-4635
Mailing Address - Fax:423-702-7789
Practice Address - Street 1:14821 DAYTON PIKE
Practice Address - Street 2:
Practice Address - City:SALE CREEK
Practice Address - State:TN
Practice Address - Zip Code:37373-5752
Practice Address - Country:US
Practice Address - Phone:423-486-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily