Healthcare Provider Details

I. General information

NPI: 1619731262
Provider Name (Legal Business Name): QUINTIN MEMKEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613
US

IV. Provider business mailing address

3100 E FLETCHER AVE
TAMPA FL
33613
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-4770
  • Fax: 813-467-4243
Mailing address:
  • Phone: 813-467-4770
  • Fax: 813-467-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number11033985
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: