Provider Demographics
NPI:1679142681
Name:STARR, JASMINE (NP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:STARR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:STARR
Other - Last Name:WISEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:724 TAPESTRY PARK LOOP APT 132
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5620
Practice Address - Country:US
Practice Address - Phone:804-355-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily