Provider Demographics
NPI:1881584712
Name:AMBROSIO, JASMINE NICOLE (DC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:NICOLE
Last Name:AMBROSIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MEGAN WAY
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6869
Mailing Address - Country:US
Mailing Address - Phone:407-756-9327
Mailing Address - Fax:
Practice Address - Street 1:305 N LAKEMONT AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3204
Practice Address - Country:US
Practice Address - Phone:407-756-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15570111N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes111N00000XChiropractic ProvidersChiropractor