Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F310004-01 | NY |
N | 363LG0600X | Nurse Practitioner - Gerontology | F310004-01 | NY |
NPI | 1053916619 |
---|---|
Provider Name | Miss France Irma Jasmin |
First Address | North Baldwin, NY 11510-1003 |
Second Address | Lawrence, NY 11559-1029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2020 |
Last Update Date | 02/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F310004-01 | STATE OF NEW YORK (01) | NY |