Provider Demographics
NPI:1790927176
Name:JIMENEZ, OTONIEL (AFRNP)
Entity Type:Individual
Prefix:
First Name:OTONIEL
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:AFRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4363 MAGNOLIA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-5009
Mailing Address - Country:US
Mailing Address - Phone:754-244-2954
Mailing Address - Fax:
Practice Address - Street 1:2148 HACIENDA TER
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-2237
Practice Address - Country:US
Practice Address - Phone:754-244-2954
Practice Address - Fax:954-306-0455
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL07-265246ZC0007X
FL9489531163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant