MEDICARE: ESTEFANY CACERES JIMENEZ FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ15201000	NJ

General Provider Information

NPI Number	:	1063238939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTEFANY CACERES JIMENEZ FNP-C

Provider Business Mailing Address
First Line	:	350 MADISON GDNS
Second Line	:
City	:	OLD BRIDGE
State	:	NJ
Zip	:	08857-2820
Country	:	US
Telephone Number	:	848-466-5799
Fax Number	:

Provider Business Practice Location Address
First Line	:	1024 PARK AVE STE 6A
Second Line	:
City	:	PLAINFIELD
State	:	NJ
Zip	:	07060-3015
Country	:	US
Telephone Number	:	908-222-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	11/25/2024

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