Provider Demographics
NPI:1679080774
Name:HEATH, JASMINE LAVON (LPN)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:LAVON
Last Name:HEATH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 BELFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1013
Mailing Address - Country:US
Mailing Address - Phone:215-391-3553
Mailing Address - Fax:
Practice Address - Street 1:6118 BELFIELD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1013
Practice Address - Country:US
Practice Address - Phone:215-391-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA305602164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse