Healthcare Provider Details

I. General information

NPI: 1851815302
Provider Name (Legal Business Name): ADRIANA JENKINS HAIR LOSS SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7402 N 56TH ST STE 909
TAMPA FL
33617-7733
US

IV. Provider business mailing address

PO BOX 11434
TAMPA FL
33680-1434
US

V. Phone/Fax

Practice location:
  • Phone: 813-534-0025
  • Fax:
Mailing address:
  • Phone: 813-534-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCL1229896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: