Healthcare Provider Details

I. General information

NPI: 1063425031
Provider Name (Legal Business Name): NICOLE QUESNETTE MORGAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 TAMPA RD STE 22 ATLANTIS CLINIC
OLDSMAR FL
34677-6346
US

IV. Provider business mailing address

3705 TAMPA RD STE 22 ATLANTIS CLINIC
OLDSMAR FL
34677-6346
US

V. Phone/Fax

Practice location:
  • Phone: 813-891-6343
  • Fax: 813-891-6342
Mailing address:
  • Phone: 813-891-6343
  • Fax: 813-891-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9104263
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104263
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9104263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: