Provider Demographics
NPI:1073499521
Name:JOSE, JASMIN (FNP-C)
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38646 WAKEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-8957
Mailing Address - Country:US
Mailing Address - Phone:248-872-4598
Mailing Address - Fax:
Practice Address - Street 1:38646 WAKEFIELD CT
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-8957
Practice Address - Country:US
Practice Address - Phone:248-872-4598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704351339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily