Provider Demographics
NPI:1831343193
Name:FIRKINS, JACKIE L
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:L
Last Name:FIRKINS
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 1:12335 E SUTTER MILL ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9724
Mailing Address - Country:US
Mailing Address - Phone:520-207-1333
Mailing Address - Fax:
Practice Address - Street 1:12335 E SUTTER MILL ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9724
Practice Address - Country:US
Practice Address - Phone:520-207-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4393385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child