Healthcare Provider Details

I. General information

NPI: 1386181584
Provider Name (Legal Business Name): MS. DEBBIE MCQUAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 NE THISTLE AVE
PINETTA FL
32350-2624
US

IV. Provider business mailing address

386 NE THISTLE AVE
PINETTA FL
32350-2624
US

V. Phone/Fax

Practice location:
  • Phone: 850-464-6270
  • Fax:
Mailing address:
  • Phone: 850-464-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: