Provider Demographics
NPI:1013358423
Name:JAZMIN SERRA
Entity Type:Organization
Organization Name:JAZMIN SERRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAZMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-775-5685
Mailing Address - Street 1:160 INTERNATIONAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5057
Mailing Address - Country:US
Mailing Address - Phone:321-775-5685
Mailing Address - Fax:
Practice Address - Street 1:160 INTERNATIONAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5057
Practice Address - Country:US
Practice Address - Phone:321-775-5685
Practice Address - Fax:407-650-2699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMAZING COMPANIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-13
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233395251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022390100Medicaid