MEDICARE: MARIA TRANQUILINA JIMENEZ NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP136347	TX

General Provider Information

NPI Number	:	1124529490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA TRANQUILINA JIMENEZ NP-C

Provider Business Mailing Address
First Line	:	1620 CHURCHILL DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76209-1344
Country	:	US
Telephone Number	:	940-595-3175
Fax Number	:

Provider Business Practice Location Address
First Line	:	4206 S INTERSTATE 35 E
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76207
Country	:	US
Telephone Number	:	940-382-6900
Fax Number	:	940-382-1005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	03/17/2018

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