Provider Demographics
NPI:1871360313
Name:JENKINS, NINA MARIE (LMT, MTI)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MARIE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LMT, MTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15030 N. ELDRIDGE PKWY
Mailing Address - Street 2:STE. B
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429
Mailing Address - Country:US
Mailing Address - Phone:346-808-5718
Mailing Address - Fax:
Practice Address - Street 1:15030 N. ELDRIDGE PKWY
Practice Address - Street 2:STE. B
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-7742
Practice Address - Country:US
Practice Address - Phone:346-808-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT103488225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty