Provider Demographics
NPI:1760282370
Name:FLORES, JASMIN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:FLORES
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:
Other - Last Name:WYCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1525 N RENAISSANCE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6827
Mailing Address - Country:US
Mailing Address - Phone:505-243-3387
Mailing Address - Fax:
Practice Address - Street 1:1525 N RENAISSANCE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6827
Practice Address - Country:US
Practice Address - Phone:505-243-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83188363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health