Healthcare Provider Details

I. General information

NPI: 1154553154
Provider Name (Legal Business Name): TASHA Y JENKINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7302 JACKMAN RD
TEMPERANCE MI
48182-1315
US

IV. Provider business mailing address

4405 N HOLLAND SYLVANIA RD SUITE 104
TOLEDO OH
43623-3529
US

V. Phone/Fax

Practice location:
  • Phone: 734-850-8902
  • Fax:
Mailing address:
  • Phone: 419-882-6784
  • Fax: 419-882-4795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301093861
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: