Provider Demographics
NPI:1912890757
Name:RIVERA, JENNIFER ANNE RESPICIO (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER ANNE
Middle Name:RESPICIO
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17832 PRESCOTT LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6433
Mailing Address - Country:US
Mailing Address - Phone:626-377-2250
Mailing Address - Fax:
Practice Address - Street 1:17832 PRESCOTT LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6433
Practice Address - Country:US
Practice Address - Phone:626-377-2250
Practice Address - Fax:626-377-2250
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA665281163W00000X
CA95033553363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse