MEDICARE: NIMBA HOLDINGS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	335G00000X	Medical Foods Supplier
3	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1356182901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIMBA HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	3343 BRACHENBURY LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-3709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4955 SUMMIT ARBOR DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-3337
Country	:	US
Telephone Number	:	424-394-5554
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	SAYE ZENGBEAN
Credential	:
Telephone Number	:	424-394-5554

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	06/05/2024

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