Healthcare Provider Details

I. General information

NPI: 1053236646
Provider Name (Legal Business Name): AMY JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39883 HIGHWAY 27
DAVENPORT FL
33837-7802
US

IV. Provider business mailing address

39883 HIGHWAY 27
DAVENPORT FL
33837-7802
US

V. Phone/Fax

Practice location:
  • Phone: 863-421-9157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: