Basic Information
| Provider Information | |||||||||
| NPI: | 1548687676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14750 NW 77TH CT STE 100 | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330161507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864851005 | ||||||||
| FaxNumber: | 7864412156 | ||||||||
| Practice Location | |||||||||
| Address1: | 13701 BRUCE B DOWNS BLVD | ||||||||
| Address2: | STE 106 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136328861 | ||||||||
| FaxNumber: | 8139771742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2014 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0600X | RN 9365577 | FL | N | Nursing Service Providers | Registered Nurse | Gerontology | 163WH0200X | 28210108A | IN | N | Nursing Service Providers | Registered Nurse | Home Health | 363LF0000X | ARNP9365577 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.