Healthcare Provider Details

I. General information

NPI: 1790927176
Provider Name (Legal Business Name): OTONIEL JIMENEZ AFRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 HACIENDA TER
WESTON FL
33327-2237
US

IV. Provider business mailing address

4363 MAGNOLIA RIDGE DR
WESTON FL
33331-5009
US

V. Phone/Fax

Practice location:
  • Phone: 754-244-2954
  • Fax: 954-306-0455
Mailing address:
  • Phone: 754-244-2954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number07-265
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number9489531
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: