Healthcare Provider Details

I. General information

NPI: 1962317826
Provider Name (Legal Business Name): HEIDI J JENKINS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 HENDERSON BLVD STE 303
TAMPA FL
33629-5021
US

IV. Provider business mailing address

5943 45TH AVE N
ST PETERSBURG FL
33709-5104
US

V. Phone/Fax

Practice location:
  • Phone: 727-459-5569
  • Fax:
Mailing address:
  • Phone: 727-459-5569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA39760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: