Healthcare Provider Details

I. General information

NPI: 1841107281
Provider Name (Legal Business Name): JESSE JIMENEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SE OCEAN BLVD STE 340
STUART FL
34994-3502
US

IV. Provider business mailing address

1455 90TH AVE LOT 13
VERO BEACH FL
32966-7560
US

V. Phone/Fax

Practice location:
  • Phone: 772-220-3439
  • Fax:
Mailing address:
  • Phone: 772-321-5368
  • Fax: 772-321-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: