Provider Demographics
NPI:1760102784
Name:SHAW, JASMINE RAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:RAY
Last Name:SHAW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11037 SHINING STAR CIR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4192
Mailing Address - Country:US
Mailing Address - Phone:602-754-4250
Mailing Address - Fax:
Practice Address - Street 1:3330 S BROADWAY UNIT 11007
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2428
Practice Address - Country:US
Practice Address - Phone:720-874-2896
Practice Address - Fax:720-246-2932
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997824-NP207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine