Provider Demographics
NPI:1124841903
Name:BASS, JASMINE NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:NICOLE
Last Name:BASS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 BISHOP ST NW APT 2413
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4482
Mailing Address - Country:US
Mailing Address - Phone:678-358-8426
Mailing Address - Fax:
Practice Address - Street 1:507 BISHOP ST NW APT 2413
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4482
Practice Address - Country:US
Practice Address - Phone:678-358-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA249088363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner