Provider Demographics
NPI:1114372596
Name:DORIVAL, JIMMY (APRN)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:DORIVAL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 MULBERRY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4520
Mailing Address - Country:US
Mailing Address - Phone:561-282-8295
Mailing Address - Fax:
Practice Address - Street 1:672 SW PRIMA VISTA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-1820
Practice Address - Country:US
Practice Address - Phone:772-905-2560
Practice Address - Fax:772-336-8341
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16-270246ZC0007X
FL11019774363L00000X
FLAPRN11019774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner