Healthcare Provider Details

I. General information

NPI: 1922507243
Provider Name (Legal Business Name): JACQUELINE JIMENEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 SCHOENERSVILLE RD
BETHLEHEM PA
18017-7306
US

IV. Provider business mailing address

4712 YORKSHIRE DR
MACUNGIE PA
18062-8256
US

V. Phone/Fax

Practice location:
  • Phone: 610-807-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342587
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP021717
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22675489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: