Provider Demographics
NPI:1649670324
Name:JENKINS, ANGELLE
Entity type:Individual
Prefix:MRS
First Name:ANGELLE
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELLE
Other - Middle Name:
Other - Last Name:ALEXANDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5566 METROWEST BLVD
Mailing Address - Street 2:#2-107
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-1966
Mailing Address - Country:US
Mailing Address - Phone:407-461-4300
Mailing Address - Fax:
Practice Address - Street 1:5566 METROWEST BLVD
Practice Address - Street 2:#2-107
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-1966
Practice Address - Country:US
Practice Address - Phone:407-461-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker