Healthcare Provider Details

I. General information

NPI: 1548687676
Provider Name (Legal Business Name): KRISTIN NICOLE JENKINS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 BRUCE B DOWNS BLVD STE 106
TAMPA FL
33613
US

IV. Provider business mailing address

14750 NW 77TH CT STE 100
MIAMI LAKES FL
33016-1507
US

V. Phone/Fax

Practice location:
  • Phone: 813-632-8861
  • Fax: 813-977-1742
Mailing address:
  • Phone: 786-485-1005
  • Fax: 786-441-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN 9365577
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number28210108A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9365577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: