Provider Demographics
NPI:1861802878
Name:GAINER, JASMINE LAKENDRA (CNA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LAKENDRA
Last Name:GAINER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 5TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-2141
Mailing Address - Country:US
Mailing Address - Phone:386-249-2491
Mailing Address - Fax:
Practice Address - Street 1:815 5TH ST SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2141
Practice Address - Country:US
Practice Address - Phone:386-249-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL250136376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide