Provider Demographics
NPI:1144041179
Name:JIMENEZ, BRIANNA Y
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:Y
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 WINKLER AVE APT 433
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9436
Mailing Address - Country:US
Mailing Address - Phone:239-738-1247
Mailing Address - Fax:
Practice Address - Street 1:11922 FAIRWAY LAKES DR STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8384
Practice Address - Country:US
Practice Address - Phone:239-219-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician