Healthcare Provider Details

I. General information

NPI: 1063804904
Provider Name (Legal Business Name): JAZMIN CACERES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 646-241-1936
  • Fax: 213-609-0922
Mailing address:
  • Phone: 646-241-1936
  • Fax: 213-609-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number591181
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401756
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343374
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: