Provider Demographics
NPI:1902492283
Name:SMITH, JASMINE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 57TH DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-5344
Mailing Address - Country:US
Mailing Address - Phone:954-729-8066
Mailing Address - Fax:
Practice Address - Street 1:5985 SILVER FALLS RUN STE 200
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-1291
Practice Address - Country:US
Practice Address - Phone:941-907-4737
Practice Address - Fax:941-907-9493
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110525000Medicaid