Provider Demographics
NPI:1790132678
Name:JENKINS, JESSICA JEAN (CNM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 PRIMROSE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3589
Mailing Address - Country:US
Mailing Address - Phone:813-769-2778
Mailing Address - Fax:813-769-2779
Practice Address - Street 1:5380 PRIMROSE LAKE CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3589
Practice Address - Country:US
Practice Address - Phone:813-769-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027551176B00000X
IN09000273A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Yes176B00000XOther Service ProvidersMidwife