Provider Demographics
NPI:1306720537
Name:LOCKARD, JASMINE
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SILAS DR SW APT 216
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-2972
Mailing Address - Country:US
Mailing Address - Phone:386-324-6226
Mailing Address - Fax:
Practice Address - Street 1:1010 E ROSE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-2016
Practice Address - Country:US
Practice Address - Phone:863-413-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)