Healthcare Provider Details

I. General information

NPI: 1104238963
Provider Name (Legal Business Name): CYNTHIA ANN VENECIA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 FOSTER AVE
ARCATA CA
95521-5986
US

IV. Provider business mailing address

1150 FOSTER AVE
ARCATA CA
95521-5986
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-2481
  • Fax: 707-826-8623
Mailing address:
  • Phone: 707-826-8610
  • Fax: 707-826-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125441
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: