MEDICARE: JASMINE ROSE ESSA PA-C

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	363A00000X	Physician Assistant	0010-15457	NC
2	2080P0207X	Pediatric Hematology & Oncology Physician	0010-15457	NC

General Provider Information

NPI Number	:	1437031564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE ROSE ESSA PA-C

Provider Business Mailing Address
First Line	:	100 KIMEL FOREST DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6074
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-4085
Fax Number	:	336-716-3010

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

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	02/26/2026

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