Healthcare Provider Details

I. General information

NPI: 1962154690
Provider Name (Legal Business Name): JASMINA TERZIC APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 COMMERCIAL CT STE B
VENICE FL
34292-1656
US

IV. Provider business mailing address

3355 DALHART CT
NORTH PORT FL
34286-5468
US

V. Phone/Fax

Practice location:
  • Phone: 396-906-9062
  • Fax:
Mailing address:
  • Phone: 314-526-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2017034814
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022015591
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11036565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: