Provider Demographics
NPI:1154016913
Name:JENKINS, JESSE MAE
Entity type:Individual
Prefix:MRS
First Name:JESSE
Middle Name:MAE
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 1:2343 CRAWFORDVILLE HWY STE 107-87
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1171
Mailing Address - Country:US
Mailing Address - Phone:448-215-4109
Mailing Address - Fax:
Practice Address - Street 1:2343 CRAWFORDVILLE HWY STE 107-87
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-1171
Practice Address - Country:US
Practice Address - Phone:448-215-4109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA457672376K00000X
FL239316376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No376J00000XNursing Service Related ProvidersHomemaker