Provider Demographics
NPI:1457176117
Name:JENKINS, AMANDA BROOKE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BROOKE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BROADWAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-2458
Mailing Address - Country:US
Mailing Address - Phone:205-485-4229
Mailing Address - Fax:
Practice Address - Street 1:104 BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2458
Practice Address - Country:US
Practice Address - Phone:205-485-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy