Provider Demographics
NPI:1710656756
Name:REINHARDT, JAZMIN M (PA-C)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:M
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAZMIN
Other - Middle Name:
Other - Last Name:TABLAZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:1100 GOETHALS DR STE E
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3301
Practice Address - Country:US
Practice Address - Phone:509-942-3095
Practice Address - Fax:509-942-3097
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61347237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant