Healthcare Provider Details

I. General information

NPI: 1083026025
Provider Name (Legal Business Name): TIMOTHY DANIEL JENKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST
TACOMA WA
98405-4933
US

IV. Provider business mailing address

670 GLADES RD STE 400
BOCA RATON FL
33431-6464
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-4101
  • Fax:
Mailing address:
  • Phone: 561-955-2570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60739952
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0449621
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: