NPIMap

Organization Active NPI

Imagine Pediatrics of Florida LLC

  • Pediatrics Physician
  • Tampa, FL
National Provider Identifier
1104542232
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
IMAGINE PEDIATRICS OF FLORIDA LLC
Practice address
3109 W Dr Martin Luther King Jr Blvd Ste 350
Tampa, FL 33607-6208
Phone
(833) 208-7770
NPI assigned
Oct 19, 2022
Last updated
Aug 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Raymond Jiminez
Title
General Manager
Phone
(833) 208-7770

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
PharmacistGroup: 193200000X MULTI-SPECIALTY GROUP 183500000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X
Critical Care Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0222X

Addresses

Primary practice location

3109 W Dr Martin Luther King Jr Blvd Ste 350
Tampa, FL 33607-6208

Mailing address

PO Box 34103
Belfast, ME 04915-0619
Phone (833) 208-7770

Other practice location 1

333 SE 2nd Ave
Miami, FL 33131-2176
Phone (504) 470-4140

National Provider Directory

National Provider Directory

Locations

3109 W Mlk Blvd
Tampa, FL 33607
Phone (813) 289-0760

3109 W Mlk Blvd
#J
Tampa, FL 33607

3109 W Mlk Blvd
Ste 340
Tampa, FL 33607

3109 W Mlk Blvd
Ste 350
Tampa, FL 33607

220 Athens Way
Ste 240A
Nashville, TN 37228

3200 Southwest Fwy
Ste 2100
Houston, TX 77027
Phone (314) 374-9216

Practitioners & affiliated clinicians

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 44

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755475200000",
    "number": "1104542232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34103",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049150619",
            "telephone_number": "833-208-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 W DR MARTIN LUTHER KING JR BLVD STE 350",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076208",
            "telephone_number": "833-208-7770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 SE 2nd Ave",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331312176",
            "country_code": "US",
            "telephone_number": "504-470-4140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMAGINE PEDIATRICS OF FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-19",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A",
        "authorized_official_last_name": "JIMINEZ",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "833-208-7770"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0222X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.