Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | F02211231 | FL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 11011976 | FL |
NPI | 1073108791 |
---|---|
Provider Name | Jasmine Wasif |
First Address | Wellington, FL 33414-5912 |
Second Address | Wellington, FL 33414-5912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2021 |
Last Update Date | 04/03/2021 |