Provider Demographics
NPI:1760488308
Name:JIMENEZ-RAMOS, JACQUELINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:JIMENEZ-RAMOS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S TAMIAMI TRL STE 302
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2221
Mailing Address - Country:US
Mailing Address - Phone:941-366-9711
Mailing Address - Fax:941-957-0079
Practice Address - Street 1:12959 PALMS WEST DR STE 230
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4940
Practice Address - Country:US
Practice Address - Phone:561-790-2258
Practice Address - Fax:561-791-7489
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3424363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA3424OtherPA STATE LICENSE
FLP100450001Medicare UPIN