Provider Demographics
NPI:1396558912
Name:BROOKS, JAZMINE (CPT)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 W WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619-3544
Mailing Address - Country:US
Mailing Address - Phone:844-784-2502
Mailing Address - Fax:
Practice Address - Street 1:137 S SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-1858
Practice Address - Country:US
Practice Address - Phone:780-714-4935
Practice Address - Fax:780-714-4935
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24R-1173246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy