Healthcare Provider Details

I. General information

NPI: 1699059618
Provider Name (Legal Business Name): MOLLY E JIMENEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CYPRESS EDGE DR STE 202 STE 101
PALM COAST FL
32164
US

IV. Provider business mailing address

20 CYPRESS EDGE DR STE 202 STE 101
PALM COAST FL
32164
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-4462
  • Fax: 386-586-4463
Mailing address:
  • Phone: 386-586-4462
  • Fax: 386-586-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9183641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: