Provider Demographics
NPI:1285643056
Name:JONES, JIMA L (TE AL PTR)
Entity Type:Individual
Prefix:
First Name:JIMA
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:TE AL PTR
Other - Prefix:
Other - First Name:SONOTECH
Other - Middle Name:
Other - Last Name:IMAGING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1611 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-6816
Mailing Address - Country:US
Mailing Address - Phone:772-465-1500
Mailing Address - Fax:772-465-0050
Practice Address - Street 1:2401 FRIST BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4839
Practice Address - Country:US
Practice Address - Phone:772-465-1500
Practice Address - Fax:772-465-0050
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14477246XS1301X, 2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4204Medicare PIN