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General NPI Number Information
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NPI Number | 1386818052
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Entity Type | Individual
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Provider Name | MS. STEFANI DAWN JENKINS
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Gender | Female
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 3163 CONVERSE AVE
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City | SPRING HILL
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State | FL
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Zip | 34608-4110
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Country | US
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Telephone | 352-346-6611
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Fax | 352-835-4333
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Provider Business Mailing Address
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Address Line | 3163 CONVERSE AVE
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City | SPRING HILL
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State | FL
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Zip | 34608-4110
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Country | US
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Telephone | 352-346-6611
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Fax | 352-835-4333
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | FL
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