Provider Demographics
NPI:1215509336
Name:JIMENEZ, DIANA ALEXIS (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:ALEXIS
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 W MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-1203
Mailing Address - Country:US
Mailing Address - Phone:480-652-8965
Mailing Address - Fax:
Practice Address - Street 1:3229 E GREENWAY RD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4508
Practice Address - Country:US
Practice Address - Phone:602-788-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily