Provider Demographics
NPI:1285110262
Name:JIMENEZ CASALS, JOHAN MARY (ARNP)
Entity type:Individual
Prefix:
First Name:JOHAN MARY
Middle Name:
Last Name:JIMENEZ CASALS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 E 30TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3300
Mailing Address - Country:US
Mailing Address - Phone:786-853-7834
Mailing Address - Fax:
Practice Address - Street 1:7150 W 20TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5509
Practice Address - Country:US
Practice Address - Phone:786-209-2111
Practice Address - Fax:786-209-2092
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9423594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily