Healthcare Provider Details

I. General information

NPI: 1144154501
Provider Name (Legal Business Name): JOYCE JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3890 SW 64TH AVE APT 413
DAVIE FL
33314-2588
US

V. Phone/Fax

Practice location:
  • Phone: 787-313-8401
  • Fax:
Mailing address:
  • Phone: 787-313-8401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPSI46190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: