Provider Demographics
NPI:1760084206
Name:JIMENEZ, VANESSA (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 DOGWOOD RD STE B200 #2064
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7213
Mailing Address - Country:US
Mailing Address - Phone:470-342-8578
Mailing Address - Fax:
Practice Address - Street 1:2336 WISTERIA DR STE 110
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6162
Practice Address - Country:US
Practice Address - Phone:470-481-7803
Practice Address - Fax:833-941-5113
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily