Healthcare Provider Details

I. General information

NPI: 1619685252
Provider Name (Legal Business Name): JASMINE MARIAH JAMES DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WEST RD
ELLINGTON CT
06029-5700
US

IV. Provider business mailing address

20 KENT CT
MIDDLETOWN CT
06457-4524
US

V. Phone/Fax

Practice location:
  • Phone: 860-454-0678
  • Fax:
Mailing address:
  • Phone: 860-853-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14635
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number181626
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: