Provider Demographics
NPI:1407546781
Name:JACKSON, JASMINE LASHAE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:LASHAE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:J
Other - Last Name:MATHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7117 SW ARCHER RD LOT 2438
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4651
Mailing Address - Country:US
Mailing Address - Phone:352-214-1183
Mailing Address - Fax:
Practice Address - Street 1:7117 SW ARCHER RD LOT 2438
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4651
Practice Address - Country:US
Practice Address - Phone:352-214-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion