Healthcare Provider Details

I. General information

NPI: 1437012747
Provider Name (Legal Business Name): JASMINE LUCY ANNE IVY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 NW 189TH TERR SUITE C
MIAMI GARDENS FL
33169
US

IV. Provider business mailing address

170 NW 189TH TERR SUITE C
MIAMI GARDENS FL
33169
US

V. Phone/Fax

Practice location:
  • Phone: 305-650-1685
  • Fax: 305-675-2297
Mailing address:
  • Phone: 305-650-1685
  • Fax: 305-675-2297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11042717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: