Provider Demographics
NPI:1154113256
Name:ROBERTS, JASMIEN (MD)
Entity type:Individual
Prefix:
First Name:JASMIEN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 S WILMOT RD APT 4213
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-2281
Mailing Address - Country:US
Mailing Address - Phone:520-272-1001
Mailing Address - Fax:
Practice Address - Street 1:3225 S WILMOT RD APT 4213
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-2281
Practice Address - Country:US
Practice Address - Phone:520-272-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD09403453152WL0500X, 156FC0800X, 163WC1600X, 207P00000X, 207RC0001X, 101YA0400X, 103G00000X, 2084P2900X, 2279H0200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health