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NPI Code Detail

MEDICARE: JESSICA PIMENTEL FNP

MEDICARE: JESSICA PIMENTEL FNP
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
1363LF0000XFamily Nurse PractitionerRN211274GA

General Provider Information

NPI Number : 1588039101
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA PIMENTEL FNP
Provider Business Mailing Address
First Line : 35 LAKE SHORE BLVD
Second Line :
City : PORT WENTWORTH
State : GA
Zip : 31407-3612
Country : US
Telephone Number : 912-547-4699
Fax Number :
Provider Business Practice Location Address
First Line : 303 FRASER DRIVE
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-3712
Country : US
Telephone Number : 912-877-2227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2015
Last Update Date : 12/08/2015

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