Provider Demographics
NPI:1124745260
Name:JIMENEZ, JESSE CISNEROS JR (MSN, FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:CISNEROS
Last Name:JIMENEZ
Suffix:JR
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 S BRIDGEGATE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8227
Mailing Address - Country:US
Mailing Address - Phone:575-574-7338
Mailing Address - Fax:
Practice Address - Street 1:1289 S BRIDGEGATE DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-8227
Practice Address - Country:US
Practice Address - Phone:575-574-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ243298363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ141398Medicaid