Provider Demographics
NPI:1639752058
Name:JENKINS, TONYA TOMIKA (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:TOMIKA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WYATT LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8769
Mailing Address - Country:US
Mailing Address - Phone:843-330-9949
Mailing Address - Fax:
Practice Address - Street 1:106 WYATT LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8769
Practice Address - Country:US
Practice Address - Phone:843-330-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC919861744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management