Provider Demographics
NPI:1952984510
Name:ELIA, JASMINE AVEA (MSN, APRN, PMHNP- BC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:AVEA
Last Name:ELIA
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 FACTORIA BLVD SE STE 305
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5259
Mailing Address - Country:US
Mailing Address - Phone:206-800-0593
Mailing Address - Fax:
Practice Address - Street 1:4122 FACTORIA BLVD SE STE 305
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-5259
Practice Address - Country:US
Practice Address - Phone:206-800-0593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX918044163WP0808X
TX1050064363LP0808X
WAAP61218114363LP0808X, 363LP0808X
VA0024182384363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1275286098OtherGROUP NPI
WA1952984510OtherNPI INDIVIDUAL