Healthcare Provider Details

I. General information

NPI: 1164914636
Provider Name (Legal Business Name): RENEE M QUEZADA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

2080 CHILD ST
JACKSONVILLE FL
32214-5005
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7419
  • Fax: 904-542-7839
Mailing address:
  • Phone: 904-542-7419
  • Fax: 904-542-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60852927
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: