Healthcare Provider Details

I. General information

NPI: 1396351961
Provider Name (Legal Business Name): JASMIN ROSE THOMAS DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASMIN ROSE JOY DNP, FNP-BC

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

V. Phone/Fax

Practice location:
  • Phone: 224-425-1167
  • Fax:
Mailing address:
  • Phone: 224-425-1167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.024075
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.024075
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.409681
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: