Provider Demographics
NPI:1932473386
Name:WALLACE, JASMIA NYREE (FNP)
Entity type:Individual
Prefix:MS
First Name:JASMIA
Middle Name:NYREE
Last Name:WALLACE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ATHENS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 ATHENS WAY STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1308
Practice Address - Country:US
Practice Address - Phone:615-270-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025072363LF0000X
KY3019056363LF0000X
IL209027385363LF0000X
COC-APN.0100636-C-NP363LF0000X
GARN217995363LF0000X
TX1100729363LF0000X
MI4704401026363LF0000X
NY353211363LF0000X
TN16419363LF0000X
MN11335363LF0000X
MDAC005558363LF0000X
OR10011868363LF0000X
PASP028130363LF0000X
DELG-0012297363LF0000X
FLAPRN11002307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily