Provider Demographics
NPI:1619685252
Name:JAMES, JASMINE MARIAH (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MARIAH
Last Name:JAMES
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KIEFT RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4034
Mailing Address - Country:US
Mailing Address - Phone:860-853-8173
Mailing Address - Fax:
Practice Address - Street 1:105 WEST RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-5700
Practice Address - Country:US
Practice Address - Phone:860-454-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT181626163W00000X
CT14635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
598475020OtherPASSPORT