Healthcare Provider Details

I. General information

NPI: 1760976153
Provider Name (Legal Business Name): JASMINE MARIE TEAMER MSN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date: 12/21/2018
Reactivation Date: 02/27/2019

III. Provider practice location address

450 NEWNAN LAKES BLVD
NEWNAN GA
30263-6342
US

IV. Provider business mailing address

7100 OAKLEY CT
UNION CITY GA
30291-7104
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP315067
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN315067
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704301382
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP315067
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704301382
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: