Provider Demographics
NPI:1538643218
Name:PIMENTEL, NOEMI (NURSE PRACTIONER)
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 N 99TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-0001
Mailing Address - Country:US
Mailing Address - Phone:623-322-5700
Mailing Address - Fax:623-328-9181
Practice Address - Street 1:13640 N 99TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-0001
Practice Address - Country:US
Practice Address - Phone:623-322-5700
Practice Address - Fax:623-328-9181
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily