Healthcare Provider Details

I. General information

NPI: 1134195613
Provider Name (Legal Business Name): JENNIFER MIJARES ZIMMERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 U.S.90
PACE FL
32571-1368
US

IV. Provider business mailing address

4453 US 90
PACE FL
32571-8636
US

V. Phone/Fax

Practice location:
  • Phone: 850-436-4630
  • Fax: 850-995-2649
Mailing address:
  • Phone: 850-436-4630
  • Fax: 850-995-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0075074
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME75074
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1250003
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerUNITED HEALTHCARE
# 2
Identifier32936
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerBCBS OF FL
# 3
Identifier96036
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS OF AL
# 4
Identifier251846500
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 5
IdentifierA504
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerHEALTH FIRST NETWORK
# 6
IdentifierH8285
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerFIRST HEALTH
# 7
Identifier7960252
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerAETNA
# 8
Identifier251846500
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: