Provider Demographics
NPI:1063244564
Name:CORPUZ, JASMINE AGABIN (PA STUDENT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:AGABIN
Last Name:CORPUZ
Suffix:
Gender:F
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8775 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-2928
Mailing Address - Country:US
Mailing Address - Phone:850-607-0305
Mailing Address - Fax:
Practice Address - Street 1:5721 USA N DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0001
Practice Address - Country:US
Practice Address - Phone:251-445-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program