Provider Demographics
NPI:1861219271
Name:JIMENEZ, NICOLE CHRISTINE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 PRAIRIE HILLS VW APT 202
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3525
Mailing Address - Country:US
Mailing Address - Phone:786-271-9258
Mailing Address - Fax:
Practice Address - Street 1:6385 CORPORATE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-5912
Practice Address - Country:US
Practice Address - Phone:877-881-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician