MEDICARE: MOLLY E JIMENEZ ARNP

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	363LA2200X	Adult Health Nurse Practitioner	ARNP9183641	FL

General Provider Information

NPI Number	:	1699059618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY E JIMENEZ ARNP

Provider Business Mailing Address
First Line	:	20 CYPRESS EDGE DR STE 202
Second Line	:	STE 101
City	:	PALM COAST
State	:	FL
Zip	:	32164
Country	:	US
Telephone Number	:	386-586-4462
Fax Number	:	386-586-4463

Provider Business Practice Location Address
First Line	:	120 CYPRESS EDGE DR STE 202
Second Line	:	STE 101
City	:	PALM COAST
State	:	FL
Zip	:	32164
Country	:	US
Telephone Number	:	386-586-4462
Fax Number	:	386-586-4463

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

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	03/03/2026

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