Provider Demographics
NPI:1912258278
Name:CHARLES, JASMIN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:ELIZABETH
Last Name:CHARLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:646 E 3065 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1351
Mailing Address - Country:US
Mailing Address - Phone:801-910-2137
Mailing Address - Fax:
Practice Address - Street 1:4745 S 3200 W
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2822
Practice Address - Country:US
Practice Address - Phone:801-964-6214
Practice Address - Fax:801-858-4670
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2021-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT8441458-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant