Provider Demographics
NPI:1285399758
Name:JIMENEZ, STEFANIE ANNE (ARNP)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:ANNE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:ANNE
Other - Last Name:PAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1303 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:52339-1001
Mailing Address - Country:US
Mailing Address - Phone:641-777-3500
Mailing Address - Fax:
Practice Address - Street 1:421 E MERLE HIBBS BLVD
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1888
Practice Address - Country:US
Practice Address - Phone:641-752-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA165560363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner