Provider Demographics
NPI:1013188366
Name:JIMENEZ, JULIE ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10740 CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-2324
Mailing Address - Country:US
Mailing Address - Phone:727-709-2061
Mailing Address - Fax:
Practice Address - Street 1:10740 CHARLOTTE DR
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-2324
Practice Address - Country:US
Practice Address - Phone:727-709-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP31042235Z00000X
TX117169235Z00000X
MESP3186235Z00000X
FLSA9835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892828200Medicaid