Provider Demographics
NPI:1154902807
Name:ALICIA JIMENEZ APRN LLC
Entity type:Organization
Organization Name:ALICIA JIMENEZ APRN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-932-0299
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty