Individual
MS. JASMIN JELISSA MALLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1968 PEACHTREE RD NW, ATLANTA, GA 30309-1281
(404) 605-3775
Mailing address
1011 NW 187TH AVE, PEMBROKE PINES, FL 33029-2913
(954) 554-6902
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041453148
IL
163WG0000X
General Practice Registered Nurse
9314734
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
11014374
FL
367500000X
Certified Registered Nurse Anesthetist
209016078
IL
367500000X
Certified Registered Nurse Anesthetist
RN9314734
GA
Other
Enumeration date
11/08/2016
Last updated
07/18/2024
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