1619914157 NPI number — MRS. JAZMYN KAREN PINSON LMT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619914157 NPI number — MRS. JAZMYN KAREN PINSON LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINSON
Provider First Name:
JAZMYN
Provider Middle Name:
KAREN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PINSON
Provider Other First Name:
JAZMYN
Provider Other Middle Name:
KAREN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619914157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 156
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE TOXAWAY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28747-0156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-724-1453
Provider Business Mailing Address Fax Number:
866-620-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 GLENGARY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34231-3606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-925-3557
Provider Business Practice Location Address Fax Number:
941-925-3557
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA23169 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C8574 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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