Healthcare Provider Details

I. General information

NPI: 1053002089
Provider Name (Legal Business Name): JASMINE NAIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13020 PARK BLVD
SEMINOLE FL
33776-3639
US

IV. Provider business mailing address

13020 PARK BLVD
SEMINOLE FL
33776-3639
US

V. Phone/Fax

Practice location:
  • Phone: 727-393-3404
  • Fax: 727-392-3663
Mailing address:
  • Phone: 727-393-3404
  • Fax: 727-392-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: