Healthcare Provider Details

I. General information

NPI: 1073108791
Provider Name (Legal Business Name): JASMINE WASIF APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 03/04/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11714 GREENBRIAR CIR
WELLINGTON FL
33414-5912
US

IV. Provider business mailing address

11714 GREENBRIAR CIR
WELLINGTON FL
33414-5912
US

V. Phone/Fax

Practice location:
  • Phone: 754-368-8340
  • Fax:
Mailing address:
  • Phone: 754-368-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberF02211231
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: