MEDICARE: FELICIA QUINN CSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SM0705X	Medical-Surgical Clinical Nurse Specialist	3029	FL

General Provider Information

NPI Number	:	1073779815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA QUINN CSA

Provider Business Mailing Address
First Line	:	7329 SMITHBROOKE DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7203
Country	:	US
Telephone Number	:	770-985-4257
Fax Number	:	770-985-4258

Provider Business Practice Location Address
First Line	:	7329 SMITHBROOKE DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7203
Country	:	US
Telephone Number	:	770-985-4257
Fax Number	:	770-985-4258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	07/31/2008

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