Provider Demographics
NPI:1679329080
Name:JENKINS FAMILY NURSING MEDICAL PRACTICE, INC
Entity type:Organization
Organization Name:JENKINS FAMILY NURSING MEDICAL PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:909-230-8930
Mailing Address - Street 1:3333 CONCOURS STE 4200
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-6547
Mailing Address - Country:US
Mailing Address - Phone:092-308-9309
Mailing Address - Fax:951-379-7001
Practice Address - Street 1:3333 CONCOURS STE 4200
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-6547
Practice Address - Country:US
Practice Address - Phone:909-230-8930
Practice Address - Fax:951-379-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service