Provider Demographics
NPI:1124669379
Name:JASMIN-ST. FLEUR, JOAKIME (RN)
Entity type:Individual
Prefix:
First Name:JOAKIME
Middle Name:
Last Name:JASMIN-ST. FLEUR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5565
Mailing Address - Country:US
Mailing Address - Phone:516-799-2912
Mailing Address - Fax:
Practice Address - Street 1:74 MONROE AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5565
Practice Address - Country:US
Practice Address - Phone:516-799-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY445175-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice