Provider Demographics
NPI:1558126680
Name:HACKETT, JASMINE VINGCO (FNP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:VINGCO
Last Name:HACKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-0141
Mailing Address - Country:US
Mailing Address - Phone:619-403-4805
Mailing Address - Fax:
Practice Address - Street 1:2 COATES DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6758
Practice Address - Country:US
Practice Address - Phone:619-403-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF352619-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily