Provider Demographics
NPI:1396542403
Name:JENKINS, JACQUETTA ALGELRINA (LPN)
Entity type:Individual
Prefix:
First Name:JACQUETTA
Middle Name:ALGELRINA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16011
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6011
Mailing Address - Country:US
Mailing Address - Phone:904-908-7712
Mailing Address - Fax:
Practice Address - Street 1:508 KIT ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2026
Practice Address - Country:US
Practice Address - Phone:904-437-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver