Healthcare Provider Details

I. General information

NPI: 1205807674
Provider Name (Legal Business Name): CAROLE QUIROZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WILLIAMSON ST
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

69 CAMBRIDGE RD
MONTCLAIR NJ
07042-5035
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-5204
  • Fax:
Mailing address:
  • Phone: 973-746-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number387484
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NC08704400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number387484
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD180111
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: