Provider Demographics
NPI:1750741062
Name:JIMENEZ, HEATHER (FNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
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 1:3501 N SCOTTSDALE RD STE 334
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5641
Mailing Address - Country:US
Mailing Address - Phone:480-941-4845
Mailing Address - Fax:480-994-3058
Practice Address - Street 1:3501 N SCOTTSDALE RD STE 334
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5641
Practice Address - Country:US
Practice Address - Phone:480-941-4845
Practice Address - Fax:480-994-3058
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1750741062Medicaid