Healthcare Provider Details

I. General information

NPI: 1922792555
Provider Name (Legal Business Name): IVELISSE JIMENEZ-HOLDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2931 NEW LIFE WAY
SEBRING FL
33870-0354
US

IV. Provider business mailing address

2931 NEW LIFE WAY
SEBRING FL
33870-0354
US

V. Phone/Fax

Practice location:
  • Phone: 863-471-6227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME180491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: