Provider Demographics
NPI:1982200804
Name:JIMENEZ, CHANTEL THERESE P (NP)
Entity Type:Individual
Prefix:MS
First Name:CHANTEL THERESE
Middle Name:P
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 1:11070 N 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4705
Mailing Address - Country:US
Mailing Address - Phone:602-795-9480
Mailing Address - Fax:
Practice Address - Street 1:11070 N 24TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4705
Practice Address - Country:US
Practice Address - Phone:602-795-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN195007163W00000X
AZ260688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse