Provider Demographics
NPI:1609315027
Name:POLK, JAZMINE MARIE I (CPR)
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:MARIE
Last Name:POLK
Suffix:I
Gender:F
Credentials:CPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 E HARMON AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5955
Mailing Address - Country:US
Mailing Address - Phone:702-472-2984
Mailing Address - Fax:
Practice Address - Street 1:1509 E HARMON AVE APT 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5955
Practice Address - Country:US
Practice Address - Phone:702-472-2984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program