Active NPI
Matthew Wyatt Jenkins, MSOM BHS LMT
- Acupuncturist
- Ruskin, FL
National Provider Identifier
1417573122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AP4618
- Practice address
- 3040 E College Ave
Ruskin, FL 33570-5220 - Phone
- (813) 331-3940
- NPI assigned
- Jun 18, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA82617 | FL | |
| Acupuncturist | 171100000X | AP4618 | FL | Primary |
Addresses
Primary practice location
3040 E College Ave
Ruskin, FL 33570-5220
Mailing address
3040 E College Ave
Ruskin, FL 33570-5220
Phone (813) 331-3940
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA82617 | Other | FL | STATE OF FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP4618 | FL | MD | Acupuncturist |
| MA82617 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742169600000",
"number": "1417573122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3040 E COLLEGE AVE",
"city": "RUSKIN",
"state": "FL",
"postal_code": "335705220",
"telephone_number": "813-331-3940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3040 E COLLEGE AVE",
"city": "RUSKIN",
"state": "FL",
"postal_code": "335705220",
"telephone_number": "813-331-3940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "MATTHEW",
"middle_name": "WYATT",
"credential": "MSOM BHS LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-06-18",
"last_updated": "2025-03-17",
"certification_date": "2025-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA82617",
"primary": false
},
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "FL",
"license": "AP4618",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF FL",
"identifier": "MA82617",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ruskin, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.