Healthcare Provider Details

I. General information

NPI: 1710326517
Provider Name (Legal Business Name): DR. AWBREE W O'QUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 COUNTY ROAD 210 WEST
ST. JOHNS FL
32259
US

IV. Provider business mailing address

2233 COUNTY ROAD 210 WEST
ST. JOHNS FL
32259
US

V. Phone/Fax

Practice location:
  • Phone: 904-494-8115
  • Fax:
Mailing address:
  • Phone: 904-494-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN20135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: