Healthcare Provider Details

I. General information

NPI: 1689181646
Provider Name (Legal Business Name): JASMINE SIERRA TUBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 E MAIN ST
COLUMBUS OH
43205-1713
US

IV. Provider business mailing address

881 E MAIN ST
COLUMBUS OH
43205-1713
US

V. Phone/Fax

Practice location:
  • Phone: 614-284-9192
  • Fax:
Mailing address:
  • Phone: 614-284-9192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: