Provider Demographics
NPI:1386267102
Name:COLLINS, JAZMINE (DOM)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 SPINNAKER LOOP
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-2598
Mailing Address - Country:US
Mailing Address - Phone:512-893-3376
Mailing Address - Fax:
Practice Address - Street 1:5305 MCNUTT RD STE 204
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9605
Practice Address - Country:US
Practice Address - Phone:512-893-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDOM1271171100000X
FLAP4348171100000X
TXAC01964171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist