Provider Demographics
NPI:1023505278
Name:JENKINS, NICOLE SHERI (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SHERI
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S DALE MABRY HWY # 376
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2820
Mailing Address - Country:US
Mailing Address - Phone:206-900-3092
Mailing Address - Fax:
Practice Address - Street 1:5350 BRIDGE ST APT 5412
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3292
Practice Address - Country:US
Practice Address - Phone:206-900-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX827451163WL0100X
FL9538015163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant