Healthcare Provider Details

I. General information

NPI: 1851679732
Provider Name (Legal Business Name): KIMBERLY M JIMENEZ RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 UNIVERSITY BLVD S SUITE 104
JACKSONVILLE FL
32216-2762
US

IV. Provider business mailing address

PO BOX 43667
JACKSONVILLE FL
32203-3667
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-1171
  • Fax: 904-725-1622
Mailing address:
  • Phone: 904-224-5189
  • Fax: 904-725-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9269242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: