Provider Demographics
NPI:1417218595
Name:GIANZERO, JEREMY LEE (RN)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:LEE
Last Name:GIANZERO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 E CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5561
Mailing Address - Country:US
Mailing Address - Phone:719-238-5317
Mailing Address - Fax:
Practice Address - Street 1:783 E CHELSEA DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-5561
Practice Address - Country:US
Practice Address - Phone:719-238-5317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO186628163W00000X
AZ328243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse