Provider Demographics
NPI:1326866401
Name:JIMENEZ, STEPHANY C (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:C
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOODSIDE CT UNIT 1204
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4885
Mailing Address - Country:US
Mailing Address - Phone:860-304-8197
Mailing Address - Fax:
Practice Address - Street 1:100 WOODSIDE CT UNIT 1204
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4885
Practice Address - Country:US
Practice Address - Phone:860-304-8197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13782363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health