Provider Demographics
NPI:1376213611
Name:GRAVES, JASMINE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 CANOPY CREEK WAY APT 207
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-0200
Mailing Address - Country:US
Mailing Address - Phone:317-496-8036
Mailing Address - Fax:
Practice Address - Street 1:2375 CANOPY CREEK WAY APT 207
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-0200
Practice Address - Country:US
Practice Address - Phone:317-496-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014902363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health