Healthcare Provider Details

I. General information

NPI: 1811648488
Provider Name (Legal Business Name): ANDY ALEXANDER JIMENEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

16921 SW 94TH AVE
PALMETTO BAY FL
33157-4420
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-5511
  • Fax:
Mailing address:
  • Phone: 786-416-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11017366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: