Healthcare Provider Details

I. General information

NPI: 1689173858
Provider Name (Legal Business Name): SANDRA MICHELE QUINN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 MURPHY MILL RD
DOTHAN AL
36303-1595
US

IV. Provider business mailing address

101 LIGHTHOUSE DR
DOTHAN AL
36305-7307
US

V. Phone/Fax

Practice location:
  • Phone: 334-677-6001
  • Fax:
Mailing address:
  • Phone: 334-714-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-097557
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: