Healthcare Provider Details

I. General information

NPI: 1992292775
Provider Name (Legal Business Name): JASMINE D NORTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HUNTERS CREEK BLVD
ORLANDO FL
32837-6901
US

IV. Provider business mailing address

4921 FELLS COVE AVE
KISSIMMEE FL
34744-9237
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-2502
  • Fax:
Mailing address:
  • Phone: 407-694-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9376896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: