Healthcare Provider Details

I. General information

NPI: 1417794108
Provider Name (Legal Business Name): JAZZMINE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22001 FAIRMOUNT BLVD
CLEVELAND OH
44118-4819
US

IV. Provider business mailing address

22001 FAIRMOUNT BLVD
CLEVELAND OH
44118-4819
US

V. Phone/Fax

Practice location:
  • Phone: 216-482-8093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberRN.499930
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN.499930
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: