Provider Demographics
NPI:1033921648
Name:JENKINS, MONIQUE ANJANUE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ANJANUE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9421 DUNBAR DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-3014
Mailing Address - Country:US
Mailing Address - Phone:510-459-8613
Mailing Address - Fax:
Practice Address - Street 1:9421 DUNBAR DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-3014
Practice Address - Country:US
Practice Address - Phone:510-459-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95029082363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner