MEDICARE: JASON JIMENEZ PSYD

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	103TC0700X	Clinical Psychologist	PY11972	FL

General Provider Information

NPI Number	:	1194501973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON JIMENEZ PSYD

Provider Business Mailing Address
First Line	:	2029 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6132
Country	:	US
Telephone Number	:	954-751-0000
Fax Number	:	954-697-9516

Provider Business Practice Location Address
First Line	:	7000 W PALMETTO PARK RD STE 110
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3429
Country	:	US
Telephone Number	:	561-418-6000
Fax Number	:

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

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	02/03/2026

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