MEDICARE: IMAGINE PEDIATRICS OF FLORIDA LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner
3	363LP0200X	Pediatric Nurse Practitioner
4	363LP0222X	Critical Care Pediatric Nurse Practitioner
5	101YM0800X	Mental Health Counselor
6	104100000X	Social Worker
7	106H00000X	Marriage & Family Therapist
8	133V00000X	Registered Dietitian
9	183500000X	Pharmacist
10	207R00000X	Internal Medicine Physician
11	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104542232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGINE PEDIATRICS OF FLORIDA LLC

Provider Business Mailing Address
First Line	:	PO BOX 34103
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-0619
Country	:	US
Telephone Number	:	833-208-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 W DR MARTIN LUTHER KING JR BLVD STE 350
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6208
Country	:	US
Telephone Number	:	833-208-7770
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	RAYMOND JIMINEZ
Credential	:
Telephone Number	:	833-208-7770

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	08/18/2025

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