Healthcare Provider Details

I. General information

NPI: 1629779160
Provider Name (Legal Business Name): JASMINE ALYSSA WHITCOMB CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 N CALVERT ST STE 201
BALTIMORE MD
21202-3604
US

IV. Provider business mailing address

18 HARTLEY CIR APT 432
GARRISON MD
21117-5290
US

V. Phone/Fax

Practice location:
  • Phone: 410-633-6300
  • Fax:
Mailing address:
  • Phone: 443-909-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR231321
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: