Provider Demographics
NPI:1598229387
Name:ENMON, YASMINE TIARA (NP-C)
Entity Type:Individual
Prefix:
First Name:YASMINE
Middle Name:TIARA
Last Name:ENMON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 PEACHTREE RD NE UNIT 1107
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1475
Mailing Address - Country:US
Mailing Address - Phone:229-251-9495
Mailing Address - Fax:
Practice Address - Street 1:3324 PEACHTREE RD NE UNIT 1107
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1475
Practice Address - Country:US
Practice Address - Phone:229-251-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN242560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty