Provider Demographics
NPI:1417410655
Name:JENKINS, CAROLE L (APRN)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 DR MARTIN LUTHER KING JR BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-7126
Mailing Address - Country:US
Mailing Address - Phone:561-720-2443
Mailing Address - Fax:561-877-5042
Practice Address - Street 1:1665 DR MARTIN LUTHER KING JR BLVD STE 12
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-7126
Practice Address - Country:US
Practice Address - Phone:561-720-2443
Practice Address - Fax:561-877-5042
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNP11002116363LF0000X
FLAPRN11002116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty