Provider Demographics
NPI:1750112769
Name:ARCHIE, JASMIN (FNP)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:ARCHIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 W US HIGHWAY 30 # 183
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1854
Mailing Address - Country:US
Mailing Address - Phone:219-680-9399
Mailing Address - Fax:
Practice Address - Street 1:5501 S 1100 W
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46391-9335
Practice Address - Country:US
Practice Address - Phone:219-785-2511
Practice Address - Fax:317-232-3992
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015548A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner