Healthcare Provider Details

I. General information

NPI: 1003613506
Provider Name (Legal Business Name): ROXANA JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 KILLIAN RD
COVENTRY TOWNSHIP OH
44319-2525
US

IV. Provider business mailing address

597 KILLIAN RD
COVENTRY TOWNSHIP OH
44319-2525
US

V. Phone/Fax

Practice location:
  • Phone: 617-970-0536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number469898
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: