Provider Demographics
NPI:1134981921
Name:LUCKETT-EPPS, JASMINE (NP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:LUCKETT-EPPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 OLD CANOE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-1400
Mailing Address - Country:US
Mailing Address - Phone:202-759-4214
Mailing Address - Fax:320-207-9107
Practice Address - Street 1:3564 AVALON PARK BLVD E STE 1-A742
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7365
Practice Address - Country:US
Practice Address - Phone:202-759-4214
Practice Address - Fax:320-207-9107
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029923363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health