Provider Demographics
NPI:1669676938
Name:JIMENEZ, SHIRLEY PATRICIA (PA)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:PATRICIA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1898 W HILLSBORO BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1434
Mailing Address - Country:US
Mailing Address - Phone:954-571-9392
Mailing Address - Fax:
Practice Address - Street 1:1898 W HILLSBORO BLVD STE H
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1434
Practice Address - Country:US
Practice Address - Phone:954-571-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant