Provider Demographics
NPI:1942952841
Name:HARDAWAY, JASMINE SEARA (RN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:SEARA
Last Name:HARDAWAY
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 1:4492 STEAMBOAT SPRINGS DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1406
Mailing Address - Country:US
Mailing Address - Phone:904-482-8301
Mailing Address - Fax:
Practice Address - Street 1:669 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5467
Practice Address - Country:US
Practice Address - Phone:904-482-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN-9427164163WC0200X
FLRN9427164163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine