Provider Demographics
NPI:1346802667
Name:BROCKER, JASMINE MOIRE (RN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MOIRE
Last Name:BROCKER
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 1:10468 ESTATE LN
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75161-7043
Mailing Address - Country:US
Mailing Address - Phone:903-340-5412
Mailing Address - Fax:
Practice Address - Street 1:10468 ESTATE LN
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75161-7043
Practice Address - Country:US
Practice Address - Phone:903-340-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX971537163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse