Provider Demographics
NPI:1427340892
Name:LESNICK, JAZMIN LARISA (MD)
Entity type:Individual
Prefix:DR
First Name:JAZMIN
Middle Name:LARISA
Last Name:LESNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAZMIN
Other - Middle Name:LARISA
Other - Last Name:OVERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:501 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-4429
Mailing Address - Fax:
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3509
Practice Address - Country:US
Practice Address - Phone:941-917-7490
Practice Address - Fax:941-917-1308
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136281208000000X
NE27347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid