Basic Information
| Provider Information | |||||||||
| NPI: | 1124527734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMADOR JIMENEZ | ||||||||
| FirstName: | DAMISELA | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10550 NW 77TH CT | ||||||||
| Address2: | STE 308 | ||||||||
| City: | HIALEAH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330162072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053000791 | ||||||||
| FaxNumber: | 9546075728 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 SW 84TH AVE STE B | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333242731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549453510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2018 | ||||||||
| LastUpdateDate: | 09/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ARNP9393735 | FL | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | ARNP9393735 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ARNP9393735 | 01 | FL | DOH LICENSE | OTHER |