Provider Demographics
NPI:1902674708
Name:JIMENEZ, LEYANIS (APRN CPNP-PC)
Entity Type:Individual
Prefix:
First Name:LEYANIS
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:APRN CPNP-PC
Other - Prefix:
Other - First Name:LEYANIS
Other - Middle Name:
Other - Last Name:AVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9062 NW 177TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6690
Mailing Address - Country:US
Mailing Address - Phone:305-926-0853
Mailing Address - Fax:
Practice Address - Street 1:7950 NW 53RD ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4653
Practice Address - Country:US
Practice Address - Phone:786-631-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029741363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics