MEDICARE: STEPHANIE JIMENEZ APRN FNP-BC

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	209.030611	IL

General Provider Information

NPI Number	:	1437973435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE JIMENEZ APRN FNP-BC

Provider Business Mailing Address
First Line	:	1945 W WILSON AVE STE 5110
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5258
Country	:	US
Telephone Number	:	630-999-7780
Fax Number	:

Provider Business Practice Location Address
First Line	:	7348 N WINCHESTER AVE UNIT B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-1509
Country	:	US
Telephone Number	:	630-999-7780
Fax Number	:

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

Provider Enumeration Date	:	11/14/2024
Last Update Date	:	01/07/2026

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