Provider Demographics
NPI:1932772118
Name:EDWARDS, JASMINE RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:RAE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 GLEN COVE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4236
Mailing Address - Country:US
Mailing Address - Phone:207-301-5737
Mailing Address - Fax:207-301-5333
Practice Address - Street 1:4 GLEN COVE DR STE 103
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4236
Practice Address - Country:US
Practice Address - Phone:207-301-5737
Practice Address - Fax:207-301-5333
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA2230363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant