Provider Demographics
NPI:1962023127
Name:JENKINS, TIFFANY ROSE (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ROSE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NE THORNTON PL
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8021
Mailing Address - Country:US
Mailing Address - Phone:206-520-2405
Mailing Address - Fax:206-520-2450
Practice Address - Street 1:331 NE THORNTON PL
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8021
Practice Address - Country:US
Practice Address - Phone:206-520-2405
Practice Address - Fax:206-520-2450
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program