Provider Demographics
NPI:1801673447
Name:RODRIGUEZ, JASMINE (MSN FNP-C)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:6649 CHRISPHALT DR STE 103
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-8500
Practice Address - Country:US
Practice Address - Phone:484-287-1111
Practice Address - Fax:484-287-1117
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028445363LF0000X
PARN652894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily