Provider Demographics
NPI:1134195613
Name:ZIMMERMAN, JENNIFER MIJARES (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MIJARES
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4453 US 90
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8636
Mailing Address - Country:US
Mailing Address - Phone:850-436-4630
Mailing Address - Fax:850-995-2649
Practice Address - Street 1:4435 U.S.90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1368
Practice Address - Country:US
Practice Address - Phone:850-436-4630
Practice Address - Fax:850-995-2649
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075074208000000X
FLME75074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1250003OtherUNITED HEALTHCARE
FL32936OtherBCBS OF FL
AL96036OtherBCBS OF AL
FL251846500Medicaid
FLA504OtherHEALTH FIRST NETWORK
FLH8285OtherFIRST HEALTH
FL7960252OtherAETNA