Provider Demographics
NPI:1427681378
Name:WARRIS, JASMINE (PA-C)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:WARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10920 MOSS PARK RD STE 106
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6087
Mailing Address - Country:US
Mailing Address - Phone:407-821-3582
Mailing Address - Fax:
Practice Address - Street 1:10920 MOSS PARK RD STE 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6087
Practice Address - Country:US
Practice Address - Phone:407-821-3582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant