Provider Demographics
NPI:1417218850
Name:WEAVER, JASMINE T (DO)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:T
Last Name:WEAVER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 CYPRESS VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6801
Mailing Address - Country:US
Mailing Address - Phone:813-634-2500
Mailing Address - Fax:813-634-3008
Practice Address - Street 1:781 CYPRESS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6801
Practice Address - Country:US
Practice Address - Phone:813-633-3600
Practice Address - Fax:813-634-8210
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270415-1207Q00000X
FLOS13377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015458300Medicaid