Provider Demographics
NPI:1710036454
Name:JIMENEZ, TAMMY (RD, LD, IBCLC, CPM,)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RD, LD, IBCLC, CPM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 W TWIN LAKES DR.
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704
Mailing Address - Country:US
Mailing Address - Phone:409-382-7040
Mailing Address - Fax:903-496-0361
Practice Address - Street 1:5555 W. TWIN LAKES DR.
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75704
Practice Address - Country:US
Practice Address - Phone:409-382-7040
Practice Address - Fax:903-496-0361
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07165133V00000X
174N00000X
L-17418174N00000X
TX99311176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN