Provider Demographics
NPI:1124867106
Name:HIGHTOWER, JASMINE CHARMAINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:CHARMAINE
Last Name:HIGHTOWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:CHARMAINE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:NUNEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30448-0072
Mailing Address - Country:US
Mailing Address - Phone:912-678-4936
Mailing Address - Fax:
Practice Address - Street 1:517 NUNEZ LEXSY RD
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-5219
Practice Address - Country:US
Practice Address - Phone:912-678-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA163W00000X163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice