Provider Demographics
NPI:1124527163
Name:JENKINS, ASHLEY LOIS
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LOIS
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-1565
Mailing Address - Country:US
Mailing Address - Phone:813-270-3788
Mailing Address - Fax:
Practice Address - Street 1:4922 WILDFLOWER DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-1565
Practice Address - Country:US
Practice Address - Phone:813-270-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician