Provider Demographics
NPI:1699059618
Name:JIMENEZ, MOLLY E (ARNP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:E
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2551 W EAU GALLIE BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8961
Mailing Address - Country:US
Mailing Address - Phone:321-752-5544
Mailing Address - Fax:321-752-5957
Practice Address - Street 1:2551 W EAU GALLIE BLVD
Practice Address - Street 2:STE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8961
Practice Address - Country:US
Practice Address - Phone:321-752-5544
Practice Address - Fax:321-752-5957
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9183641363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health