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General NPI Number Information
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NPI Number | 1639806904
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Entity Type | Individual
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Provider Name | CICELY LATOYA JENKINS CEO
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Gender | Female
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 464 INVESTORS PL STE 206E
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1384
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Country | US
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Telephone | 757-384-3232
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Fax | 757-384-3223
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Provider Business Mailing Address
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Address Line | 4736 ELDON CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-7228
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Country | US
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Telephone | 757-559-3107
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Fax |
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 1401203256
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License Number State | VA
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