Provider Demographics
NPI:1063309144
Name:LLAVE, JENNY LEE PALENCIA (MSN, RN)
Entity type:Individual
Prefix:
First Name:JENNY LEE
Middle Name:PALENCIA
Last Name:LLAVE
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MACDILL AFB 6TH MEDICAL GROUP
Mailing Address - Street 2:3250 ZEMKE AVENUE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33608
Mailing Address - Country:US
Mailing Address - Phone:520-429-0044
Mailing Address - Fax:
Practice Address - Street 1:3250 ZEMKE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-5023
Practice Address - Country:US
Practice Address - Phone:520-429-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18810100163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice