MEDICARE: MRS. ANNA ALICIA JIMENEZ WHNP

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	363LW0102X	Women's Health Nurse Practitioner	689377	TX

General Provider Information

NPI Number	:	1316279631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA ALICIA JIMENEZ WHNP

Provider Business Mailing Address
First Line	:	10410 MEDICAL LOOP BLDG 4B
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6672
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10410 MEDICAL LOOP BLDG 4B
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6672
Country	:	US
Telephone Number	:	956-794-8870
Fax Number	:

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

Provider Enumeration Date	:	02/11/2010
Last Update Date	:	02/26/2015

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