1437671153 NPI number — ERIC K JENKINS APRN

Table of content: ERIC K JENKINS APRN (NPI 1437671153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437671153 NPI number — ERIC K JENKINS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKINS
Provider First Name:
ERIC
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437671153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2699
Provider Second Line Business Mailing Address:
ATTN: SHMG/HPE
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32513-2699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-267-1603
Provider Business Mailing Address Fax Number:
850-622-3342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7720 US HIGHWAY 98 W STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32550-7231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-267-1603
Provider Business Practice Location Address Fax Number:
850-622-3342
Provider Enumeration Date:
07/13/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN9429770 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 022033600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".