Provider Demographics
NPI:1083189112
Name:JIMENEZ, NAOMI NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:NICOLE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-954-7500
Mailing Address - Fax:702-304-7451
Practice Address - Street 1:15021 W BELL RD STE 125
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3916
Practice Address - Country:US
Practice Address - Phone:623-476-7880
Practice Address - Fax:623-476-7890
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily