MEDICARE: MS. PATRICIA ANN QUINN NP

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	363LF0000X	Family Nurse Practitioner	256412	CA

General Provider Information

NPI Number	:	1477761807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA ANN QUINN NP

Provider Business Mailing Address
First Line	:	1325 DELLCREST LN
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-5207
Country	:	US
Telephone Number	:	858-454-4323
Fax Number	:

Provider Business Practice Location Address
First Line	:	4490 FANUEL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4292
Country	:	US
Telephone Number	:	858-274-9116
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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