Provider Demographics
NPI:1851805253
Name:PUNNOOSE, JASMINE LUKOSE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LUKOSE
Last Name:PUNNOOSE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RIPLEY ST
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2618
Mailing Address - Country:US
Mailing Address - Phone:773-308-3716
Mailing Address - Fax:
Practice Address - Street 1:150 RIPLEY ST
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2618
Practice Address - Country:US
Practice Address - Phone:773-308-3716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019364363LF0000X
IL209016562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily