Provider Demographics
NPI:1801604483
Name:DORTCH, JASMA (CRNP)
Entity type:Individual
Prefix:
First Name:JASMA
Middle Name:
Last Name:DORTCH
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46005 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-7722
Mailing Address - Country:US
Mailing Address - Phone:251-654-4712
Mailing Address - Fax:
Practice Address - Street 1:450 SAINT EMANUEL ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-2240
Practice Address - Country:US
Practice Address - Phone:251-574-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-162323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily