Provider Demographics
NPI:1689834574
Name:NATIVIDAD, JENNIFER JACINTO (RN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JACINTO
Last Name:NATIVIDAD
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 1:6331 TURNEY RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5246
Mailing Address - Country:US
Mailing Address - Phone:216-224-5400
Mailing Address - Fax:
Practice Address - Street 1:6331 TURNEY RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5246
Practice Address - Country:US
Practice Address - Phone:216-224-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN338119163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse