MEDICARE: MS. JASMINE PATRICE DARK FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP131652	TX

General Provider Information

NPI Number	:	1053866160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JASMINE PATRICE DARK FNP-BC

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2103 FM 2920 RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-3412
Country	:	US
Telephone Number	:	713-461-2915
Fax Number	:	713-461-5307

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2016
Last Update Date	:	05/14/2024

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