Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9480015 | FL |
NPI | 1003364209 |
---|---|
Provider Name | Amy Jenkins |
First Address | Jacksonville, FL 32259-4057 |
Second Address | Jacksonville, FL 32259-4057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2016 |
Last Update Date | 20/03/2018 |