Provider Demographics
NPI:1861936213
Name:GAUSE, JASMINE (FNP-C)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:GAUSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 COBB PKWY NW
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5766
Mailing Address - Country:US
Mailing Address - Phone:678-574-5678
Mailing Address - Fax:678-574-5605
Practice Address - Street 1:3451 COBB PKWY NW
Practice Address - Street 2:SUITE 4
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5766
Practice Address - Country:US
Practice Address - Phone:678-574-5678
Practice Address - Fax:678-574-5605
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAF0216908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily