MEDICARE: ERIN MICHELLE JIMENEZ RN

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	164X00000X	Licensed Vocational Nurse	342554	TX
2	163W00000X	Registered Nurse	1074906	TX

General Provider Information

NPI Number	:	1184109126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MICHELLE JIMENEZ RN

Provider Business Mailing Address
First Line	:	5306 LA CRESENTA ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-4421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4707 BROADWAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-6215
Country	:	US
Telephone Number	:	210-829-7561
Fax Number	:

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

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	02/26/2025

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