Healthcare Provider Details

I. General information

NPI: 1396206843
Provider Name (Legal Business Name): JASMINE KIRBY THOMAS MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

PO BOX 744785
ATLANTA GA
30374-4785
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-5324
  • Fax: 954-985-3453
Mailing address:
  • Phone: 202-476-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125074699
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD210002100
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME174141
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME174141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: