Healthcare Provider Details

I. General information

NPI: 1033860671
Provider Name (Legal Business Name): ERICA LEIGH O'QUINN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 REVOLUTIONARY TRL
FAIRFAX SC
29827-7109
US

IV. Provider business mailing address

86 WREN ST
BARNWELL SC
29812-1529
US

V. Phone/Fax

Practice location:
  • Phone: 803-632-2533
  • Fax: 803-632-2451
Mailing address:
  • Phone: 803-259-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25723
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: