Provider Demographics
NPI:1073195434
Name:PRINCE, JASMINE OLIVIA (MD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:OLIVIA
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER
Mailing Address - Street 2:395 W 12TH AVE, THIRD FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-2528
Mailing Address - Country:US
Mailing Address - Phone:614-293-3989
Mailing Address - Fax:614-293-9789
Practice Address - Street 1:THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER
Practice Address - Street 2:395 W 12TH AVE, THIRD FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-2528
Practice Address - Country:US
Practice Address - Phone:614-293-3989
Practice Address - Fax:614-293-9789
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
OH57.250956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program