Provider Demographics
NPI:1902314214
Name:JENKINS, RUTHELL
Entity Type:Individual
Prefix:
First Name:RUTHELL
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
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 863
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-0863
Mailing Address - Country:US
Mailing Address - Phone:863-206-7960
Mailing Address - Fax:
Practice Address - Street 1:3720 WILLIAMS LANDING CIR UNIT 208
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9130
Practice Address - Country:US
Practice Address - Phone:863-206-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services