Provider Demographics
NPI:1417551573
Name:JIMENEZ, NICOLE ANGELA (FNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANGELA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANGELA
Other - Last Name:LORING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5534
Mailing Address - Country:US
Mailing Address - Phone:603-315-2659
Mailing Address - Fax:
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3599
Practice Address - Country:US
Practice Address - Phone:603-669-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH065187-21363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner