Provider Demographics
NPI:1043593221
Name:JIMENEZ, ELAINE (IDMT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 MOBILITY LANE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33621
Mailing Address - Country:US
Mailing Address - Phone:940-337-1647
Mailing Address - Fax:
Practice Address - Street 1:1811 MOBILITY LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-1500
Practice Address - Country:US
Practice Address - Phone:940-337-1647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians