Provider Demographics
NPI:1194523514
Name:LYKING, JENNEA L (RN)
Entity type:Individual
Prefix:
First Name:JENNEA
Middle Name:L
Last Name:LYKING
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 TUPELO TRL
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4149
Mailing Address - Country:US
Mailing Address - Phone:347-792-1120
Mailing Address - Fax:
Practice Address - Street 1:1261 TUPELO TRL
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4149
Practice Address - Country:US
Practice Address - Phone:347-792-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9558363163WH0200X
NY974920163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse