Provider Demographics
NPI:1124501804
Name:JIMENEZ, ALICIA (ARNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W PEMBROKE RD STE 322
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2181
Mailing Address - Country:US
Mailing Address - Phone:954-932-0299
Mailing Address - Fax:954-932-0298
Practice Address - Street 1:1000 W PEMBROKE RD STE 322
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2181
Practice Address - Country:US
Practice Address - Phone:954-932-0299
Practice Address - Fax:954-932-0298
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9411892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty