Provider Demographics
NPI:1033453956
Name:CHARLON, JASMINE (APN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:CHARLON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 36TH ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4710
Mailing Address - Country:US
Mailing Address - Phone:201-320-0711
Mailing Address - Fax:
Practice Address - Street 1:334 E 25TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3179
Practice Address - Country:US
Practice Address - Phone:212-263-5489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00403600363LA2200X
NYF306142-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00403600OtherNEW JERSEY APN CERTIFICATION NUMBER
NYF306142OtherNEW YORK STATE NP LICENSE