Provider Demographics
NPI:1619372968
Name:JENKINS, TIFFANY (HCP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:HCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2629
Mailing Address - Country:US
Mailing Address - Phone:304-487-1608
Mailing Address - Fax:513-332-9904
Practice Address - Street 1:1604 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2629
Practice Address - Country:US
Practice Address - Phone:304-487-1608
Practice Address - Fax:513-332-9904
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3162237700000X
WV1008237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist