Individual
GRACIE LATRICE JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3605 LIGHT PORT WAY, KISSIMMEE, FL 34746-1842
(689) 239-9633
Mailing address
3605 LIGHT PORT WAY, KISSIMMEE, FL 34746-1842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
APRN11045076
FL
Other
Enumeration date
01/23/2026
Last updated
01/23/2026
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