Provider Demographics
NPI:1740440114
Name:JIMENEZ, VIVIAN LINDA (FNP)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:LINDA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8602 PEACH STREET
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79404-7777
Mailing Address - Country:US
Mailing Address - Phone:806-745-1021
Mailing Address - Fax:806-474-1806
Practice Address - Street 1:8602 PEACH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-7777
Practice Address - Country:US
Practice Address - Phone:806-745-1021
Practice Address - Fax:806-474-1806
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX712352363LF0000X
TXAP116841363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily