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General NPI Number Information
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NPI Number | 1104542232
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Entity Type | Organization
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Legal Business Name | IMAGINE PEDIATRICS OF FLORIDA LLC
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 3109 W DR MARTIN LUTHER KING JR BLVD STE 350
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City | TAMPA
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State | FL
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Zip | 33607-6208
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Country | US
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Telephone | 833-208-7770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34103
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City | BELFAST
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State | ME
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Zip | 04915-0619
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Country | US
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Telephone | 833-208-7770
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | RAYMOND JIMINEZ
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Credential |
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Telephone | 833-208-7770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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