Healthcare Provider Details

I. General information

NPI: 1033850631
Provider Name (Legal Business Name): AMBER RENEE JIMENEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER YOUNG

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SHIPYARD BLVD STE 100
WILMINGTON NC
28403-8019
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 910-794-5355
  • Fax: 910-794-5358
Mailing address:
  • Phone: 561-223-8081
  • Fax: 561-431-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number13504632-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2026-03864
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: