Provider Demographics
NPI:1689263626
Name:MCDONALD, JASMINE (NP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EASTERN SHORE URGENT CARE
Mailing Address - Street 2:29710 URGENT CARE DRIVE
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526
Mailing Address - Country:US
Mailing Address - Phone:251-626-3782
Mailing Address - Fax:
Practice Address - Street 1:EASTERN SHORE URGENT CARE
Practice Address - Street 2:29710 URGENT CARE DRIVE
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526
Practice Address - Country:US
Practice Address - Phone:251-626-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-09-21
Deactivation Date:2021-08-26
Deactivation Code:
Reactivation Date:2021-09-14
Provider Licenses
StateLicense IDTaxonomies
AL1-187392363LF0000X
NJ26NJ01100200363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology