Healthcare Provider Details

I. General information

NPI: 1497266944
Provider Name (Legal Business Name): MIRELYS JIMENEZ PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 MARY ST STE 300
MIAMI FL
33133-5293
US

IV. Provider business mailing address

50 W 33RD ST
HIALEAH FL
33012-5222
US

V. Phone/Fax

Practice location:
  • Phone: 305-908-1115
  • Fax: 305-675-3135
Mailing address:
  • Phone: 786-307-0497
  • Fax: 305-742-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11030672
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: