Healthcare Provider Details

I. General information

NPI: 1942952841
Provider Name (Legal Business Name): JASMINE SEARA HARDAWAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 KINGSLEY AVE
ORANGE PARK FL
32073-5467
US

IV. Provider business mailing address

4492 STEAMBOAT SPRINGS DR E
JACKSONVILLE FL
32210-1406
US

V. Phone/Fax

Practice location:
  • Phone: 904-482-8301
  • Fax:
Mailing address:
  • Phone: 904-482-8301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN-9427164
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9427164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: