Provider Demographics
NPI:1245015353
Name:KOLA-KOROLO, JASAMINE BRITTANIE (NP)
Entity type:Individual
Prefix:
First Name:JASAMINE
Middle Name:BRITTANIE
Last Name:KOLA-KOROLO
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 1:701 OLYMPIC PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1950
Mailing Address - Country:US
Mailing Address - Phone:903-596-3627
Mailing Address - Fax:
Practice Address - Street 1:701 OLYMPIC PLAZA CIR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1950
Practice Address - Country:US
Practice Address - Phone:903-596-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner