Provider Demographics
NPI:1619860897
Name:ACEVEDO, JENNA LEIGH (RN)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEIGH
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PADDOCK ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2900
Mailing Address - Country:US
Mailing Address - Phone:631-365-9672
Mailing Address - Fax:
Practice Address - Street 1:9 PADDOCK ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2900
Practice Address - Country:US
Practice Address - Phone:631-365-9672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY849872-01163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool