Provider Demographics
NPI:1700540150
Name:JENKS, SABRINA (PA-C)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:JENKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:SAYEDZADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:645-228-6038
Mailing Address - Fax:
Practice Address - Street 1:48 CENTENNIAL WAY STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4662
Practice Address - Country:US
Practice Address - Phone:864-455-1600
Practice Address - Fax:864-522-8005
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4032363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4920PAMedicaid