Provider Demographics
NPI:1740782317
Name:JIMENEZ, OTILIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:OTILIA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:OTILIA
Other - Middle Name:JIMENEZ
Other - Last Name:BARRIENTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:402 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-4608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:402 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-4608
Practice Address - Country:US
Practice Address - Phone:432-307-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644993163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse