Provider Demographics
NPI:1780916908
Name:JENKINS, TACOMA Y
Entity type:Individual
Prefix:
First Name:TACOMA
Middle Name:Y
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 1:2510 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-3056
Mailing Address - Country:US
Mailing Address - Phone:941-592-0898
Mailing Address - Fax:941-708-5404
Practice Address - Street 1:2510 11TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-3056
Practice Address - Country:US
Practice Address - Phone:941-592-0898
Practice Address - Fax:941-708-5404
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNEW251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health