Provider Demographics
NPI:1164901245
Name:FORNBACHER, JASMINA SANTOS (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JASMINA
Middle Name:SANTOS
Last Name:FORNBACHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7325 S PECOS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3768
Mailing Address - Country:US
Mailing Address - Phone:702-982-6402
Mailing Address - Fax:702-202-0674
Practice Address - Street 1:7325 S PECOS RD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3768
Practice Address - Country:US
Practice Address - Phone:702-982-6402
Practice Address - Fax:702-202-0674
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV812066363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health