Provider Demographics
NPI:1538819982
Name:STREIGHT, JASMINE MARIE (NP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MARIE
Last Name:STREIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 S UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5800
Mailing Address - Country:US
Mailing Address - Phone:858-408-5152
Mailing Address - Fax:
Practice Address - Street 1:4400 E FLAMINGO AVE STE 130
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9203
Practice Address - Country:US
Practice Address - Phone:208-205-0350
Practice Address - Fax:208-367-3131
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner