Healthcare Provider Details

I. General information

NPI: 1922988336
Provider Name (Legal Business Name): JENNA NICOLE VENEZIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000A EMELINE AVE
SANTA CRUZ CA
95060-1900
US

IV. Provider business mailing address

1000A EMELINE AVE
SANTA CRUZ CA
95060-1900
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-0112
  • Fax:
Mailing address:
  • Phone: 831-425-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number740443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: