=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740872290
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMEN ROSA DEL ROCIO JASSO FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2021
-----------------------------------------------------
Last Update Date | 10/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 WATER STONE CIR
-----------------------------------------------------
City | JOLIET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60431-8313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 779-707-8085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1113 BARBERRY WAY
-----------------------------------------------------
City | JOLIET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60431-7850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-885-1357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 209022964
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------