{
"Npi": {
"NPI": "1659831725",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JIMENEZ",
"FirstName": "JOHNNY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "JIMENEZ",
"OtherFirstName": "JOHNNY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "FNP-C",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "PO BOX 255228",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SACRAMENTO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95865-5228",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-470-0071",
"MailingAddressFaxNumber": "916-854-6769",
"FirstLinePracticeLocationAddress": "2545 W HAMMER LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STOCKTON",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95209-2839",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "209-954-4040",
"PracticeLocationAddressFaxNumber": "209-951-2239",
"EnumerationDate": "03/23/2019",
"LastUpdateDate": "12/18/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "NP95011333",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363LP2300X",
"TaxonomyName": "Primary Care Nurse Practitioner",
"LicenseNumber": "95011333",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "95039845",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}