Provider Demographics
NPI:1093207961
Name:JIMENEZ, XIOMARA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:XIOMARA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N BUCKSTOWN RD STE E100
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1815
Mailing Address - Country:US
Mailing Address - Phone:215-249-6226
Mailing Address - Fax:
Practice Address - Street 1:100 N BUCKSTOWN RD STE E100
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1815
Practice Address - Country:US
Practice Address - Phone:215-249-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN596952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily