Provider Demographics
NPI:1073890505
Name:VENEZIA SKAGGS, DARLENE G (MSN,NP-C)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:G
Last Name:VENEZIA SKAGGS
Suffix:
Gender:F
Credentials:MSN,NP-C
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:G
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 INTERSTATE PKWY
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1036
Mailing Address - Country:US
Mailing Address - Phone:814-363-2716
Mailing Address - Fax:814-363-2713
Practice Address - Street 1:116 INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1036
Practice Address - Country:US
Practice Address - Phone:814-363-2716
Practice Address - Fax:814-363-2713
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011771363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102678643Medicaid
PA237765F92Medicare PIN