MEDICARE: BARBARA JENKIN MA,CAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0755AD374301	FL

General Provider Information

NPI Number	:	1013283969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA JENKIN MA,CAP

Provider Business Mailing Address
First Line	:	248 SOUTHPARK CIRCLE EAST
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086
Country	:	US
Telephone Number	:	410-703-4133
Fax Number	:	904-797-5681

Provider Business Practice Location Address
First Line	:	248 SOUTHPARK CIR E
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-5137
Country	:	US
Telephone Number	:	410-703-4133
Fax Number	:	904-797-5681

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	03/26/2012

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