Provider Demographics
NPI:1154553154
Name:JENKINS, TASHA Y (MD)
Entity type:Individual
Prefix:DR
First Name:TASHA
Middle Name:Y
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3529
Mailing Address - Country:US
Mailing Address - Phone:419-882-6784
Mailing Address - Fax:419-882-4795
Practice Address - Street 1:7302 JACKMAN RD
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1315
Practice Address - Country:US
Practice Address - Phone:734-850-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine