Provider Demographics
NPI:1205273828
Name:JIMENEZ, DENISE MARIE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:940 BELMONT STREET BUILDING 4/UNIT 4-1-C (TCU)
Mailing Address - Street 2:V.A. MEDICAL CENTER
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:774-826-1414
Mailing Address - Fax:774-826-2073
Practice Address - Street 1:940 BELMONT STREET BUILDING 4/UNIT 4-1-C (TCU)
Practice Address - Street 2:V.A. MEDICAL CENTER
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:774-826-1414
Practice Address - Fax:774-826-2073
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN266255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily