Provider Demographics
NPI:1194501973
Name:JIMENEZ, JASON (PSYD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6132
Mailing Address - Country:US
Mailing Address - Phone:954-751-0000
Mailing Address - Fax:954-697-9516
Practice Address - Street 1:2029 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6132
Practice Address - Country:US
Practice Address - Phone:954-751-0000
Practice Address - Fax:954-697-9516
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11972103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist