Provider Demographics
NPI:1790540672
Name:ARCHER, JASMINE (RN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:ARCHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 WILLOUGHBY AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3588
Mailing Address - Country:US
Mailing Address - Phone:347-585-1674
Mailing Address - Fax:
Practice Address - Street 1:249 WILLOUGHBY AVE APT 6B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3588
Practice Address - Country:US
Practice Address - Phone:347-585-1674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY840503163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse