Healthcare Provider Details

I. General information

NPI: 1760837959
Provider Name (Legal Business Name): MYRTHA JASMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 COVINA CT
ORLANDO FL
32810-6053
US

IV. Provider business mailing address

7444 COVINA CT
ORLANDO FL
32810-6053
US

V. Phone/Fax

Practice location:
  • Phone: 904-962-0596
  • Fax:
Mailing address:
  • Phone: 904-962-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: