Provider Demographics
NPI:1386321073
Name:JENKINS, CARLOTTA LATASHA X (MD)
Entity type:Individual
Prefix:
First Name:CARLOTTA
Middle Name:LATASHA
Last Name:JENKINS
Suffix:X
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLOTTA
Other - Middle Name:LATASHA
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3206 E GIDDENS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-5142
Mailing Address - Country:US
Mailing Address - Phone:727-558-7326
Mailing Address - Fax:
Practice Address - Street 1:3206 E GIDDENS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-5142
Practice Address - Country:US
Practice Address - Phone:727-558-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker