MEDICARE: ILEN JIMENEZ

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	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1609731249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILEN JIMENEZ

Provider Business Mailing Address
First Line	:	4304 INVERNESS CT
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1902
Country	:	US
Telephone Number	:	786-405-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	4304 INVERNESS CT
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1902
Country	:	US
Telephone Number	:	786-405-2005
Fax Number	:

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

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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Directions to “ ILEN JIMENEZ ” Practice Location

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