Provider Demographics
NPI:1295470680
Name:JAMISON, AISHA SYNCLAIR
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:SYNCLAIR
Last Name:JAMISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DAVIS BLVD.
Mailing Address - Street 2:#308
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606
Mailing Address - Country:US
Mailing Address - Phone:937-775-2934
Mailing Address - Fax:
Practice Address - Street 1:17 DAVIS BLVD.
Practice Address - Street 2:#308
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-250-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-01
Last Update Date:2023-05-30
Deactivation Date:2023-04-03
Deactivation Code:
Reactivation Date:2023-05-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program