MEDICARE: JASMINE MAHBOOB MMS, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9121462	FL

General Provider Information

NPI Number	:	1053262485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE MAHBOOB MMS, PA-C

Provider Business Mailing Address
First Line	:	900 S PINE ISLAND RD STE 800
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-3923
Country	:	US
Telephone Number	:	954-967-6400
Fax Number	:	954-965-7339

Provider Business Practice Location Address
First Line	:	1714 N MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-4404
Country	:	US
Telephone Number	:	904-354-6868
Fax Number	:	904-358-3067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	04/22/2026

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