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General NPI Number Information
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NPI Number | 1669968681
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Entity Type | Organization
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Legal Business Name | JASMINE JAC LLC
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 169 SHORT RUFF WAY
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City | LAS VEGAS
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State | NV
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Zip | 89148-5259
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Country | US
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Telephone | 702-884-5258
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Fax |
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Provider Business Mailing Address
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Address Line | 5470 RENO CORPORATE DR
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City | RENO
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State | NV
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Zip | 89511-2250
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Country | US
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Telephone | 775-657-0293
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JASMINE JACOBS
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Credential | MSN, ACNP-BC.
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Telephone | 702-884-5258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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