Provider Demographics
NPI:1336277417
Name:JIMENEZ, COLEEN M (FNP)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:M
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3814
Mailing Address - Country:US
Mailing Address - Phone:718-617-2201
Mailing Address - Fax:
Practice Address - Street 1:1543 INWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-2001
Practice Address - Country:US
Practice Address - Phone:718-299-5500
Practice Address - Fax:718-299-7679
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY547529163W00000X
NYF335004363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily