Healthcare Provider Details

I. General information

NPI: 1689639361
Provider Name (Legal Business Name): KAREN QUINN RNC,NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY PEDIATRIX MEDICAL GROUP
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

2707 WEY HILL CT
AUGUSTA GA
30909-6405
US

V. Phone/Fax

Practice location:
  • Phone: 706-774-2891
  • Fax:
Mailing address:
  • Phone: 706-863-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN063713
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: