Healthcare Provider Details

I. General information

NPI: 1417802976
Provider Name (Legal Business Name): JENNIFER MARIE JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12730 NW 102ND PL
HIALEAH GARDENS FL
33018-6028
US

IV. Provider business mailing address

2685 W 66TH ST APT 24
HIALEAH GARDENS FL
33016-2848
US

V. Phone/Fax

Practice location:
  • Phone: 305-343-0783
  • Fax:
Mailing address:
  • Phone: 305-343-0783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: