Healthcare Provider Details

I. General information

NPI: 1568927648
Provider Name (Legal Business Name): JORGE QUINONES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 W FLAGLER ST STE 2I
MIAMI FL
33144-2069
US

IV. Provider business mailing address

MILLENNIUM PHYSICIAN GROUP, LLC 2675 WINKLER AVENUE, SECOND FLOOR
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 786-715-9183
  • Fax:
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: