Provider Demographics
NPI:1922560994
Name:JENKINS, JOSHUA (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7243 DELLA DR FL 3
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5104
Mailing Address - Country:US
Mailing Address - Phone:407-381-7366
Mailing Address - Fax:321-203-4609
Practice Address - Street 1:7243 DELLA DR FL 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5104
Practice Address - Country:US
Practice Address - Phone:407-381-7366
Practice Address - Fax:321-203-4609
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty