Provider Demographics
NPI:1134713068
Name:VASCONEZ, JASMINE LEONOR (APRN)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LEONOR
Last Name:VASCONEZ
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 1:415 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2838
Mailing Address - Country:US
Mailing Address - Phone:239-233-3076
Mailing Address - Fax:
Practice Address - Street 1:415 E PINE ST APT 1715
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-6629
Practice Address - Country:US
Practice Address - Phone:239-233-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine