Provider Demographics
NPI:1821736299
Name:WAGNER, JASMINE (DNP, APRN-RX, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DNP, APRN-RX, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-229 WAIPAHU DEPOT ST STE 308
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3033
Mailing Address - Country:US
Mailing Address - Phone:808-582-8881
Mailing Address - Fax:808-582-8883
Practice Address - Street 1:94-229 WAIPAHU DEPOT ST STE 404
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3034
Practice Address - Country:US
Practice Address - Phone:808-600-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily