Provider Demographics
NPI:1639767445
Name:DANIELS, JASMINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:731 NJ-57
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886-5923
Mailing Address - Country:US
Mailing Address - Phone:551-343-9684
Mailing Address - Fax:
Practice Address - Street 1:303 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2095
Practice Address - Country:US
Practice Address - Phone:201-891-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22391000163W00000X
NY707155163WE0003X
NYF346783363LF0000X
NJ26NJ01124300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency