Healthcare Provider Details

I. General information

NPI: 1134043789
Provider Name (Legal Business Name): JAZMINE CARRASCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BAXTER ST
CHARLOTTE NC
28204-3053
US

IV. Provider business mailing address

8655 WATERLYNN CIR NW APT 209
CONCORD NC
28027-0032
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-1075
  • Fax:
Mailing address:
  • Phone: 704-668-5953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: