Provider Demographics
NPI:1295065902
Name:REESE, JASMINE MARIE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:MARIE
Last Name:REESE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:MARIE
Other - Last Name:PAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13740 CYPRESS TERRACE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8827
Mailing Address - Country:US
Mailing Address - Phone:239-275-5522
Mailing Address - Fax:239-275-4464
Practice Address - Street 1:9350 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-7980
Practice Address - Country:US
Practice Address - Phone:239-481-5437
Practice Address - Fax:239-481-0570
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR71613208000000X
FLME 124530208000000X
AL31535208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL137462Medicaid
AL137579Medicaid
1511BOtherBCBSFL
FL015180300Medicaid
FLIF850ZMedicare PIN