Healthcare Provider Details

I. General information

NPI: 1013520261
Provider Name (Legal Business Name): JASMINE GIANNI NURSE WHNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP
LACKLAND AFB TX
78236-5638
US

IV. Provider business mailing address

9907 MEADOW LARK
CONVERSE TX
78109-2600
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-7412
  • Fax:
Mailing address:
  • Phone: 609-346-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP144491
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: