MEDICARE: JAZMINE MOORE DOUGLAS RN

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	163WC0400X	Case Management Registered Nurse	95187846	CA
2	163WC1500X	Community Health Registered Nurse	95187846	CA
3	163WG0000X	General Practice Registered Nurse	95187846	CA
4	163WP1700X	Perinatal Registered Nurse	95187846	CA
5	163WM0102X	Maternal Newborn Registered Nurse	95187846	CA

General Provider Information

NPI Number	:	1063341022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMINE MOORE DOUGLAS RN

Provider Business Mailing Address
First Line	:	PO BOX 2012
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305-0012
Country	:	US
Telephone Number	:	310-525-4905
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 2012
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305-0012
Country	:	US
Telephone Number	:	310-525-4905
Fax Number	:

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

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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