Provider Demographics
NPI:1639560188
Name:FORBES, JASMINE CRISTINA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:CRISTINA
Last Name:FORBES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 QUEENSMEAD PLACE
Mailing Address - Street 2:APT. F
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226
Mailing Address - Country:US
Mailing Address - Phone:317-946-4905
Mailing Address - Fax:
Practice Address - Street 1:7940 QUEENSMEAD PL
Practice Address - Street 2:APT. F
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-2093
Practice Address - Country:US
Practice Address - Phone:317-946-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer