Healthcare Provider Details

I. General information

NPI: 1619795077
Provider Name (Legal Business Name): JAZZMINE N GARCIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 WEAVER PKWY STE 100A
WARRENVILLE IL
60555-3920
US

IV. Provider business mailing address

715 SUNCREST DR
AURORA IL
60506-8828
US

V. Phone/Fax

Practice location:
  • Phone: 630-416-8289
  • Fax:
Mailing address:
  • Phone: 630-740-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010353
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number085010353
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: