Provider Demographics
NPI:1306352570
Name:JENKINS, NIKITA L (BSN, RN, RN-BC)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:F
Credentials:BSN, RN, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-0365
Mailing Address - Country:US
Mailing Address - Phone:904-769-1122
Mailing Address - Fax:
Practice Address - Street 1:1410 NE 219TH ST
Practice Address - Street 2:
Practice Address - City:LAWTEY
Practice Address - State:FL
Practice Address - Zip Code:32058-4387
Practice Address - Country:US
Practice Address - Phone:904-769-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9383636163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health