MEDICARE: JASMINE MADDEN

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	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor	5078	TN

General Provider Information

NPI Number	:	1639570013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE MADDEN

Provider Business Mailing Address
First Line	:	2000 MALLORY LN STE 290
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6287
Country	:	US
Telephone Number	:	407-274-7067
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 TUSKAWILLA RD
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-5063
Country	:	US
Telephone Number	:	407-274-7067
Fax Number	:

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

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	01/03/2023

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Directions to “ JASMINE MADDEN ” Practice Location

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