Provider Demographics
NPI:1346598331
Name:JIMENEZ, JENNIFER NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NICOLE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JJ
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:801 DOUGLAS AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ALTAMONTE SPG
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 DOUGLAS AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:ALTAMONTE SPG
Practice Address - State:FL
Practice Address - Zip Code:32714-5206
Practice Address - Country:US
Practice Address - Phone:407-830-6412
Practice Address - Fax:407-830-8413
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8842103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling