Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APRN002455 | NV |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APRN002455 | NV |
Y | 363LG0600X | Nurse Practitioner - Gerontology | APRN002455 | NV |
NPI | 1255871604 |
---|---|
Provider Name | Jasmine Jacob |
First Address | Las Vegas, NV 89109-2225 |
Second Address | Las Vegas, NV 89109-2225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2017 |
Last Update Date | 01/02/2022 |