Provider Demographics
NPI:1801665468
Name:LUCK, JASMINE MAY (PA-C)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MAY
Last Name:LUCK
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:2137 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2137 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3923
Practice Address - Country:US
Practice Address - Phone:727-822-1896
Practice Address - Fax:727-821-0932
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2024-05-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant