Healthcare Provider Details

I. General information

NPI: 1063473262
Provider Name (Legal Business Name): MARJORY W QUAMMIE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 HOLSONBACK DR
DAYTONA BEACH FL
32117-5114
US

IV. Provider business mailing address

PO BOX 9190
DAYTONA BEACH FL
32120-9190
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-0790
  • Fax: 386-274-0800
Mailing address:
  • Phone: 386-274-0790
  • Fax: 386-274-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP 1492332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: