Provider Demographics
NPI:1063087898
Name:PRACTITIONERS OF SOUTH WEST FLORIDA LLC
Entity type:Organization
Organization Name:PRACTITIONERS OF SOUTH WEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/FAMILY/PEDIATRIC NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JALIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ MOREJON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:817-655-1595
Mailing Address - Street 1:2810 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-4881
Mailing Address - Country:US
Mailing Address - Phone:817-655-1595
Mailing Address - Fax:
Practice Address - Street 1:2810 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-4881
Practice Address - Country:US
Practice Address - Phone:817-655-1595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty