Provider Demographics
NPI:1760705396
Name:JENKINS, TRACY L (APN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 EMORY VALLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7746
Mailing Address - Country:US
Mailing Address - Phone:865-685-0734
Mailing Address - Fax:865-294-4998
Practice Address - Street 1:687 EMORY VALLEY RD STE A
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-685-0734
Practice Address - Fax:865-294-4998
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily