MEDICARE: SAVI JESSICA JASSAN CERTIFICATES

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	163WH0500X	Hemodialysis Registered Nurse	CERTIFICATE	FL

General Provider Information

NPI Number	:	1578909693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVI JESSICA JASSAN CERTIFICATES

Provider Business Mailing Address
First Line	:	1901 CLEVELAND ST UNIT B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-3133
Country	:	US
Telephone Number	:	954-274-4289
Fax Number	:	954-922-2710

Provider Business Practice Location Address
First Line	:	1901 CLEVELAND ST UNIT B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-3133
Country	:	US
Telephone Number	:	954-274-4289
Fax Number	:	954-922-2710

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

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	05/15/2013

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