MEDICARE: MISS JASMINE KORDBACHEH

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	363AM0700X	Medical Physician Assistant
2	363AS0400X	Surgical Physician Assistant	PA9109934	FL

General Provider Information

NPI Number	:	1902355043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JASMINE KORDBACHEH

Provider Business Mailing Address
First Line	:	6699 W BOYNTON BEACH BLVD STE 100
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3527
Country	:	US
Telephone Number	:	561-296-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	6699 W BOYNTON BEACH BLVD STE B
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3527
Country	:	US
Telephone Number	:	561-296-1188
Fax Number	:

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

Provider Enumeration Date	:	09/30/2016
Last Update Date	:	07/22/2019

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Directions to “ MISS JASMINE KORDBACHEH ” Practice Location

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