Healthcare Provider Details

I. General information

NPI: 1891490934
Provider Name (Legal Business Name): DANILA JIMENEZ APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AIRPORT RD
SANTA TERESA NM
88008-9703
US

IV. Provider business mailing address

100 AIRPORT RD
SANTA TERESA NM
88008-9703
US

V. Phone/Fax

Practice location:
  • Phone: 575-874-9338
  • Fax: 575-874-9359
Mailing address:
  • Phone: 575-874-9338
  • Fax: 575-874-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77052
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1094315
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: