Provider Demographics
NPI:1568270049
Name:BRYANT, JAZZMINE LASHY
Entity type:Individual
Prefix:
First Name:JAZZMINE
Middle Name:LASHY
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10136 LOCKSLEY DR
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-4011
Mailing Address - Country:US
Mailing Address - Phone:214-607-2947
Mailing Address - Fax:
Practice Address - Street 1:10136 LOCKSLEY DR
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-4011
Practice Address - Country:US
Practice Address - Phone:214-607-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3S8Y7A8202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology