Provider Demographics
NPI:1629779160
Name:WHITCOMB, JASMINE ALYSSA (CRNP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALYSSA
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HARTLEY CIR APT 432
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5290
Mailing Address - Country:US
Mailing Address - Phone:443-909-0246
Mailing Address - Fax:
Practice Address - Street 1:341 N CALVERT ST STE 201
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3604
Practice Address - Country:US
Practice Address - Phone:410-633-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR231321363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health