Provider Demographics
NPI:1851679732
Name:JIMENEZ, KIMBERLY M (RN, NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RN, NP
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 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-224-5189
Mailing Address - Fax:904-725-1622
Practice Address - Street 1:3225 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2762
Practice Address - Country:US
Practice Address - Phone:904-399-1171
Practice Address - Fax:904-725-1622
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9269242363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009587100Medicaid
FLP01248790OtherRAILROAD MEDICARE
FLHO246ZMedicare PIN