Provider Demographics
NPI:1053358192
Name:JEREZ-MARTE, JASMIN MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:JASMIN
Middle Name:MARIA
Last Name:JEREZ-MARTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JASMIN
Other - Middle Name:MARIA
Other - Last Name:JEREZ-FRANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 RIVERSIDE DR E
Mailing Address - Street 2:SUITE 3900
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1008
Mailing Address - Country:US
Mailing Address - Phone:813-415-5038
Mailing Address - Fax:
Practice Address - Street 1:300 RIVERSIDE DR E
Practice Address - Street 2:SUITE 3900
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1008
Practice Address - Country:US
Practice Address - Phone:813-415-5038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238207207R00000X
FLME120734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA181708OtherANTHEM
VA3898557OtherCIGNA
VA1053358192Medicaid
VA321002OtherSOUTHERN HEALTH
VAP00236724OtherRAILROAD MEDICARE
VA010177979Medicaid
VA7191720OtherAETNA
VA181708OtherANTHEM
VA1053358192Medicaid