Provider Demographics
NPI:1285727560
Name:JENKINS, TERESA (ANP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:ELWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:304 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-1707
Mailing Address - Country:US
Mailing Address - Phone:315-251-2244
Mailing Address - Fax:315-251-2240
Practice Address - Street 1:3709 ERIE BLVD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:NY
Practice Address - Zip Code:13214-2227
Practice Address - Country:US
Practice Address - Phone:315-251-2244
Practice Address - Fax:315-251-2240
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303187363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ21958Medicare UPIN