Healthcare Provider Details

I. General information

NPI: 1124527734
Provider Name (Legal Business Name): DAMISELA AMADOR JIMENEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 SW 84TH AVE STE B
PLANTATION FL
33324-2731
US

IV. Provider business mailing address

10550 NW 77TH CT STE 308
HIALEAH GARDENS FL
33016-2072
US

V. Phone/Fax

Practice location:
  • Phone: 954-945-3510
  • Fax:
Mailing address:
  • Phone: 305-300-0791
  • Fax: 954-607-5728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9393735
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP9393735
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9393735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: