Provider Demographics
NPI:1033071790
Name:JIMENEZ, JULIE IVETTE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:IVETTE
Last Name:JIMENEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:IVETTTE
Other - Last Name:JIMENEZ MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2102
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2102
Practice Address - Street 2:
Practice Address - City:GIBSONTON
Practice Address - State:FL
Practice Address - Zip Code:33534-2102
Practice Address - Country:US
Practice Address - Phone:813-585-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty