Provider Demographics
NPI:1386803666
Name:JENKINS BAUTISTA, JOCELYN MICHELE (NP)
Entity type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:MICHELE
Last Name:JENKINS BAUTISTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:JOCELYN
Other - Middle Name:MICHELE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BLACKBURN DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2292
Mailing Address - Country:US
Mailing Address - Phone:978-281-1500
Mailing Address - Fax:978-282-3611
Practice Address - Street 1:1 BLACKBURN DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2292
Practice Address - Country:US
Practice Address - Phone:978-281-1500
Practice Address - Fax:978-282-3611
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2316993363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2316993Medicaid