Provider Demographics
NPI:1871726703
Name:JIMENEZ, EDGAR (FNP)
Entity type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 MINERAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7693
Mailing Address - Country:US
Mailing Address - Phone:915-231-9157
Mailing Address - Fax:
Practice Address - Street 1:2931 MONTANA AVE STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2409
Practice Address - Country:US
Practice Address - Phone:915-562-4246
Practice Address - Fax:915-564-0667
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX627728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily