Provider Demographics
NPI:1689275349
Name:COSTE JIMENEZ, YDALINA INMACULADA (ARNP)
Entity Type:Individual
Prefix:
First Name:YDALINA
Middle Name:INMACULADA
Last Name:COSTE JIMENEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290054
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33329-0054
Mailing Address - Country:US
Mailing Address - Phone:908-208-9396
Mailing Address - Fax:
Practice Address - Street 1:6817 COLLEGE CT
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7169
Practice Address - Country:US
Practice Address - Phone:908-208-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2024-02-21
Deactivation Date:2021-02-10
Deactivation Code:
Reactivation Date:2024-02-20
Provider Licenses
StateLicense IDTaxonomies
FL11030383363LF0000X, 363L00000X
WI20-435246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner