Provider Demographics
NPI:1053429118
Name:JENKINS, CAROLINE PORTIS (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PORTIS
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2303
Mailing Address - Country:US
Mailing Address - Phone:615-292-9770
Mailing Address - Fax:615-385-1842
Practice Address - Street 1:601 BENTON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2303
Practice Address - Country:US
Practice Address - Phone:615-292-9770
Practice Address - Fax:615-385-1842
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN8315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3640166Medicaid
Q48404Medicare UPIN