Provider Demographics
NPI:1851815302
Name:JENKINS, ADRIANA (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11434
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33680-1434
Mailing Address - Country:US
Mailing Address - Phone:813-534-0025
Mailing Address - Fax:
Practice Address - Street 1:7402 N 56TH ST STE 909
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-7733
Practice Address - Country:US
Practice Address - Phone:813-534-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL12298961744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management