Healthcare Provider Details

I. General information

NPI: 1306358981
Provider Name (Legal Business Name): ASHLEY NICHOLE QUINTANA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 LOS CANTOS AVE NW
ALBUQUERQUE NM
87114-6329
US

IV. Provider business mailing address

701 OSUNA RD NE STE 600
ALBUQUERQUE NM
87113-0009
US

V. Phone/Fax

Practice location:
  • Phone: 505-412-5247
  • Fax:
Mailing address:
  • Phone: 505-412-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-03433
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03433
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: