Provider Demographics
NPI:1083089619
Name:HOLDER, JASMIN BIANCA (RN)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:BIANCA
Last Name:HOLDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 METROPOLITAN AVE
Mailing Address - Street 2:APT 1E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6173
Mailing Address - Country:US
Mailing Address - Phone:845-538-0469
Mailing Address - Fax:
Practice Address - Street 1:1507 METROPOLITAN AVE
Practice Address - Street 2:APT 1E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6173
Practice Address - Country:US
Practice Address - Phone:845-538-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY482524163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse