Provider Demographics
NPI:1730754607
Name:SARDINEA, JASMINE DANIELLE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DANIELLE
Last Name:SARDINEA
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 1:2503 SHOAL VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2670
Mailing Address - Country:US
Mailing Address - Phone:713-839-5899
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN ST # 270-L
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX812066163WN0800X
TX1046546363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience