Healthcare Provider Details

I. General information

NPI: 1215639372
Provider Name (Legal Business Name): JOSIE QUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 MALABAR RD NE STE 200
PALM BAY FL
32907-2559
US

IV. Provider business mailing address

20900 BISCAYNE BOULEVARD PODIATRY
AVENTURA FL
33180
US

V. Phone/Fax

Practice location:
  • Phone: 321-308-2660
  • Fax: 321-984-9303
Mailing address:
  • Phone: 954-471-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: