MEDICARE: KRISTEN W. JENKINS APRN-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP9393630	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y0PQ9	OTHER	FL	FLORIDA BLUE
3	054295568	OTHER	GA	DRIVERS LICENCE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518363282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN W. JENKINS APRN-C

Provider Business Mailing Address
First Line	:	11945 SAN JOSE BLVD
Second Line	:	STE 300
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-396-1725
Fax Number	:	904-396-4893

Provider Business Practice Location Address
First Line	:	2532 CAPITAL MEDICAL BLVD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4424
Country	:	US
Telephone Number	:	850-900-1120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2014
Last Update Date	:	12/03/2021

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