Provider Demographics
NPI:1982214334
Name:HENDERSON, JASMINE ALECIA (APRN)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALECIA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PLANTATION PARK DR UNIT 4
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6035
Mailing Address - Country:US
Mailing Address - Phone:843-706-2296
Mailing Address - Fax:
Practice Address - Street 1:7 PLANTATION PARK DR UNIT 4
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6035
Practice Address - Country:US
Practice Address - Phone:843-706-2296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230138363LA2200X
SC24683363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP7404Medicaid
GARN230138OtherNURSING LICENSE NUMBER