Provider Demographics
NPI:1962741942
Name:JASMINE WOMEN'S CENTER, OBSTETRICS AND GYNECOLOGY, LLC
Entity type:Organization
Organization Name:JASMINE WOMEN'S CENTER, OBSTETRICS AND GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ACQUINONETTE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-210-0433
Mailing Address - Street 1:1983 CENTRE POINTE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7822
Mailing Address - Country:US
Mailing Address - Phone:850-210-0433
Mailing Address - Fax:
Practice Address - Street 1:1983 CENTRE POINTE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7822
Practice Address - Country:US
Practice Address - Phone:850-210-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty