Provider Demographics
NPI:1700290996
Name:COWART, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:COWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9952 66TH RD APT 7Z
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4428
Mailing Address - Country:US
Mailing Address - Phone:347-361-6114
Mailing Address - Fax:
Practice Address - Street 1:9952 66TH RD APT 7Z
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4428
Practice Address - Country:US
Practice Address - Phone:347-361-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317132164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse