Healthcare Provider Details

I. General information

NPI: 1508442518
Provider Name (Legal Business Name): NATHANIEL WILLIAM JENKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

PO BOX 16960
MIAMI FL
33101-6960
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-1315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number14279035-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: