Provider Demographics
NPI:1346437043
Name:JIMENEZ, SANDRA (DNP, ANP-BC, RN)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DNP, ANP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42-30 DOUGLASTON PKWY APT 3J
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1511
Mailing Address - Country:US
Mailing Address - Phone:718-224-4650
Mailing Address - Fax:
Practice Address - Street 1:42-30 DOUGLASTON PKWY APT 3J
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1511
Practice Address - Country:US
Practice Address - Phone:718-224-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301295163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse