Provider Demographics
NPI:1538917992
Name:JASMINE CRESANTA DNP PMHNP BC
Entity type:Organization
Organization Name:JASMINE CRESANTA DNP PMHNP BC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESANTA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP PMHNP
Authorized Official - Phone:480-309-2366
Mailing Address - Street 1:1930 S ALMA SCHOOL RD STE C204
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3043
Mailing Address - Country:US
Mailing Address - Phone:480-454-7136
Mailing Address - Fax:480-336-3080
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE C204
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3043
Practice Address - Country:US
Practice Address - Phone:480-454-7136
Practice Address - Fax:480-336-3080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JASMINE CRESANTA DNP PMHNP BC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-10
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ240332Medicaid