Healthcare Provider Details

I. General information

NPI: 1104669795
Provider Name (Legal Business Name): JONATHAN FIMMEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 NEWBERRY RD STE 104
GAINESVILLE FL
32607-2557
US

IV. Provider business mailing address

4340 NEWBERRY RD STE 104
GAINESVILLE FL
32607-2557
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-3100
  • Fax: 352-377-1286
Mailing address:
  • Phone: 352-377-3100
  • Fax: 352-377-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: