Healthcare Provider Details

I. General information

NPI: 1053521195
Provider Name (Legal Business Name): ELEANOR QUINCY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 EISENHOWER DR
SAVANNAH GA
31406
US

IV. Provider business mailing address

315 EISENHOWER DR
SAVANNAH GA
31406
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-4687
  • Fax: 912-495-8881
Mailing address:
  • Phone: 912-354-4687
  • Fax: 912-495-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN077580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: