Provider Demographics
NPI:1245599695
Name:JASMINE, TERROLYN TAMARIS
Entity type:Individual
Prefix:
First Name:TERROLYN
Middle Name:TAMARIS
Last Name:JASMINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ELLEN PARK PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-1951
Mailing Address - Country:US
Mailing Address - Phone:504-393-7855
Mailing Address - Fax:504-393-7855
Practice Address - Street 1:2100 ELLEN PARK PLACE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131
Practice Address - Country:US
Practice Address - Phone:504-393-7855
Practice Address - Fax:504-393-7855
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA273263588OtherCHILDCARE POVIDER