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General NPI Number Information
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NPI Number | 1063083798
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Entity Type | Individual
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Provider Name | EUSEBIO R JIMENEZ
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Gender | Male
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Dates
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Enumeration Date | 07/04/2021
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 85 GRAND CANAL DR STE 209
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City | MIAMI
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State | FL
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Zip | 33144-2575
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Country | US
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Telephone | 786-703-9966
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Fax | 786-703-9965
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Provider Business Mailing Address
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Address Line | 9520 SW 165TH TER
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City | MIAMI
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State | FL
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Zip | 33157-3302
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Country | US
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Telephone | 702-606-9651
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Fax | 786-703-9965
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11014051
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11014051
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License Number State | FL
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