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General NPI Number Information
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NPI Number | 1669130381
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Entity Type | Individual
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Provider Name | JASMINE MARIE MOORE
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Gender | Female
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 3400 N 29TH AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33020-1002
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Country | US
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Telephone | 954-276-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 2180 WILLIAM S. WHITE BUILDING 303 E KEARSLEY STREET
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City | FLINT
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State | MI
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Zip | 48502-1950
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Country | US
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Telephone | 810-762-3420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704318940
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9475967
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9475967
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License Number State | FL
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