Provider Demographics
NPI:1801331558
Name:MARTIN, JASMINE (MA, RMFTI)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772167
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32877-2167
Mailing Address - Country:US
Mailing Address - Phone:321-914-5350
Mailing Address - Fax:
Practice Address - Street 1:1320 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4116
Practice Address - Country:US
Practice Address - Phone:407-593-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3371106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist