Provider Demographics
NPI:1841847753
Name:DILLARD, JASMINE RENAY (APRN)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:RENAY
Last Name:DILLARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:RENAY
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1607 SAINT JAMES CT STE 2
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5352
Mailing Address - Country:US
Mailing Address - Phone:850-878-8714
Mailing Address - Fax:
Practice Address - Street 1:1607 SAINT JAMES CT STE 2
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5352
Practice Address - Country:US
Practice Address - Phone:850-878-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003840363LX0001X
FLAPRN11003840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology