Healthcare Provider Details

I. General information

NPI: 1801331558
Provider Name (Legal Business Name): JASMINE MARTIN MA, RMFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 LOUISIANA AVE
SAINT CLOUD FL
34769-4116
US

IV. Provider business mailing address

PO BOX 772167
ORLANDO FL
32877-2167
US

V. Phone/Fax

Practice location:
  • Phone: 407-593-0122
  • Fax:
Mailing address:
  • Phone: 321-914-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT3371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: