Healthcare Provider Details

I. General information

NPI: 1780173666
Provider Name (Legal Business Name): JASMINE PATINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2018
Last Update Date: 09/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 WILES RD STE 201
COCONUT CREEK FL
33073
US

IV. Provider business mailing address

4515 WILES RD STE 201
COCONUT CREEK FL
33073-3414
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-1133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9111221
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: