Provider Demographics
NPI:1609569888
Name:JIMENEZ, ANDREW DAVID (SRNA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 AMLEY PL
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-6419
Mailing Address - Country:US
Mailing Address - Phone:631-219-9559
Mailing Address - Fax:
Practice Address - Street 1:830 AMLEY PL
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-6419
Practice Address - Country:US
Practice Address - Phone:631-219-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program