Healthcare Provider Details

I. General information

NPI: 1659755429
Provider Name (Legal Business Name): JAZMINE DAVIS COLLINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2015
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 ELLIS AVE
JACKSON MS
39209-6256
US

IV. Provider business mailing address

PO BOX 746079
ATLANTA GA
30374-6079
US

V. Phone/Fax

Practice location:
  • Phone: 601-533-7016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number888947
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: