Healthcare Provider Details

I. General information

NPI: 1245190024
Provider Name (Legal Business Name): JAZZMIN BRIANA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 ROCKLEDGE DR STE 100
BETHESDA MD
20817-1847
US

IV. Provider business mailing address

6430 ROCKLEDGE DR STE 100
BETHESDA MD
20817-1847
US

V. Phone/Fax

Practice location:
  • Phone: 301-493-4334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR239774
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR239774
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: