Provider Demographics
NPI:1083846984
Name:JENKINS, TIFFANY CHARLOTTE (FNP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:CHARLOTTE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3700
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3700
Mailing Address - Country:US
Mailing Address - Phone:423-302-1350
Mailing Address - Fax:423-952-2145
Practice Address - Street 1:1497 W ELK AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2895
Practice Address - Country:US
Practice Address - Phone:423-542-7420
Practice Address - Fax:423-542-7425
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014278363LF0000X
VA0024170252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515754Medicaid
VA1083846984Medicaid
TN103I505155Medicare PIN