Provider Demographics
NPI:1821689688
Name:PENIX, GENEVA LEIGH (RN)
Entity Type:Individual
Prefix:
First Name:GENEVA
Middle Name:LEIGH
Last Name:PENIX
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 1:39639 TOWNSEND RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-1582
Mailing Address - Country:US
Mailing Address - Phone:352-410-0754
Mailing Address - Fax:
Practice Address - Street 1:39639 TOWNSEND RD
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-1582
Practice Address - Country:US
Practice Address - Phone:352-410-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9193254163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse