Provider Demographics
NPI:1871357798
Name:LINA, JASMINE NUESCA (FNP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:NUESCA
Last Name:LINA
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 1:33991 CROOKS CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48173-9323
Mailing Address - Country:US
Mailing Address - Phone:734-250-5238
Mailing Address - Fax:
Practice Address - Street 1:33991 CROOKS CT
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48173-9323
Practice Address - Country:US
Practice Address - Phone:734-250-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2023125878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily