Healthcare Provider Details

I. General information

NPI: 1841368230
Provider Name (Legal Business Name): BRIAN ANTHONY QUINN RN,NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 TESCONI CIR STE B
SANTA ROSA CA
95401-4691
US

IV. Provider business mailing address

480 TESCONI CIR STE B
SANTA ROSA CA
95401-4691
US

V. Phone/Fax

Practice location:
  • Phone: 707-206-7268
  • Fax:
Mailing address:
  • Phone: 707-206-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number367611
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP5698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: