Healthcare Provider Details

I. General information

NPI: 1720639941
Provider Name (Legal Business Name): STACEY MARIE QUINONES MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2019
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BAINBRIDGE AVE FL MAP7
BRONX NY
10467-2404
US

IV. Provider business mailing address

457 USS NEW MEXICO CT APT 3
STATEN ISLAND NY
10305-5044
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2626
  • Fax: 718-652-1833
Mailing address:
  • Phone: 347-513-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: