Healthcare Provider Details

I. General information

NPI: 1104418904
Provider Name (Legal Business Name): NICOLE RENEE QUAINOO RN, MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 E STATE ROAD 44
SHELBYVILLE IN
46176-1846
US

IV. Provider business mailing address

PO BOX 306417
NASHVILLE TN
37230-6417
US

V. Phone/Fax

Practice location:
  • Phone: 463-235-3043
  • Fax:
Mailing address:
  • Phone: 931-253-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28183194A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010954A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: