Provider Demographics
NPI:1639806904
Name:JENKINS, CICELY LATOYA (CEO)
Entity Type:Individual
Prefix:MRS
First Name:CICELY
Middle Name:LATOYA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:CICELY
Other - Middle Name:LATOYA
Other - Last Name:HAROLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:4736 ELDON CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7228
Mailing Address - Country:US
Mailing Address - Phone:757-559-3107
Mailing Address - Fax:
Practice Address - Street 1:464 INVESTORS PL STE 206E
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1384
Practice Address - Country:US
Practice Address - Phone:757-384-3232
Practice Address - Fax:757-384-3223
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401203256376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide