Provider Demographics
NPI:1730298837
Name:JENKINS, TIMOTHY JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 W UNDERWOOD ST MP # 153
Mailing Address - Street 2:ATTN LESLIE FRAZIER
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:321-842-8475
Mailing Address - Fax:407-849-6470
Practice Address - Street 1:52 W UNDERWOOD ST MP # 153
Practice Address - Street 2:ATTN LESLIE FRAZIER
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:321-842-8475
Practice Address - Fax:407-849-6470
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1470572085R0202X
TN722002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108716300Medicaid
OH020032985OtherRAILROAD MEDICARE
OH0186249Medicaid
OH0831941Medicare ID - Type Unspecified