Healthcare Provider Details

I. General information

NPI: 1356963276
Provider Name (Legal Business Name): QUINCY TREMAYNE WOODS DNP, MSO, MSN, FNP,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2569 W FLORIDA AVE # 2569
HEMET CA
92545-4615
US

IV. Provider business mailing address

2569 W FLORIDA AVE
HEMET CA
92545-4615
US

V. Phone/Fax

Practice location:
  • Phone: 519-253-6359
  • Fax: 951-925-0014
Mailing address:
  • Phone: 951-925-3635
  • Fax: 951-925-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014410
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number95182457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: