Provider Demographics
NPI:1154928554
Name:HE, JIMEI (DOM)
Entity type:Individual
Prefix:
First Name:JIMEI
Middle Name:
Last Name:HE
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24842 BLAZING TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-9584
Mailing Address - Country:US
Mailing Address - Phone:813-943-9231
Mailing Address - Fax:
Practice Address - Street 1:24842 BLAZING TRAIL WAY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-9584
Practice Address - Country:US
Practice Address - Phone:813-943-9231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34516183500000X
FLAP4171171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty