Provider Demographics
NPI:1699487165
Name:JENKINS RALEIGH, TAMMY MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:MICHELLE
Last Name:JENKINS RALEIGH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:MICHELLE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:21030 CHINABERRY DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 W SAMPLE RD STE 301
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1370
Practice Address - Country:US
Practice Address - Phone:954-266-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022950363L00000X
FLAPRN11022950363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner