Provider Demographics
NPI:1871744748
Name:JIMENEZ, SUSAN R (NP, PA-C)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:R
Last Name:JIMENEZ
Suffix:
Gender:
Credentials:NP, PA-C
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:R
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, PA-C
Mailing Address - Street 1:8754 STEELHEAD CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-8948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8754 STEELHEAD CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-8948
Practice Address - Country:US
Practice Address - Phone:650-556-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15363363A00000X
CA11392363LF0000X
NVPA1868363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP50244Medicare UPIN