Provider Demographics
NPI:1518494483
Name:DUMAS, JASMIN LANEICE (PA-C)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:LANEICE
Last Name:DUMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAYSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35073-1942
Mailing Address - Country:US
Mailing Address - Phone:205-514-3221
Mailing Address - Fax:
Practice Address - Street 1:3543 LITTLE RD STE A
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1814
Practice Address - Country:US
Practice Address - Phone:727-848-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110379363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant