Provider Demographics
NPI:1518783794
Name:JIMENEZ, KELLY GIOVANNA (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:GIOVANNA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4769 DORANDO DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3279
Mailing Address - Country:US
Mailing Address - Phone:239-776-6609
Mailing Address - Fax:
Practice Address - Street 1:4769 DORANDO DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3279
Practice Address - Country:US
Practice Address - Phone:239-776-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9625799163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse