Healthcare Provider Details

I. General information

NPI: 1841491065
Provider Name (Legal Business Name): FORREST CHRISTIAN QUIGGLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR SUITE 606
JACKSONVILLE FL
32207-8210
US

IV. Provider business mailing address

851 TRAFALGAR CT. SUITE 200E
MAITLAND FL
32751
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-3356
  • Fax: 904-398-5397
Mailing address:
  • Phone: 407-667-0444
  • Fax: 407-667-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN10398
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME105730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: