Provider Demographics
NPI:1942831821
Name:JENKINS, ANGELICA VINYA'
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:VINYA'
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 BIBB LN
Mailing Address - Street 2:
Mailing Address - City:BRENT
Mailing Address - State:AL
Mailing Address - Zip Code:35034-4040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:565 BIBB LN
Practice Address - Street 2:
Practice Address - City:BRENT
Practice Address - State:AL
Practice Address - Zip Code:35034-4040
Practice Address - Country:US
Practice Address - Phone:205-225-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-142436363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health