Basic Information
Provider Information
NPI: 1194144030
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEARGEANT
FirstName: JASMIN
MiddleName: LEAH
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1133 IBEX SQ
Address2:  
City: VENTURA
State: CA
PostalCode: 930036322
CountryCode: US
TelephoneNumber: 8315358571
FaxNumber:  
Practice Location
Address1: 400 W PUEBLO ST
Address2:  
City: SANTA BARBARA
State: CA
PostalCode: 93105
CountryCode: US
TelephoneNumber: 8056827111
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/08/2014
LastUpdateDate: 10/03/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X57025CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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