Healthcare Provider Details

I. General information

NPI: 1184589624
Provider Name (Legal Business Name): DENITA QUINN ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7691 POPLAR AVE
GERMANTOWN TN
38138-3904
US

IV. Provider business mailing address

3156 JAMES ROBERT DR
SOUTHAVEN MS
38671-6441
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-6000
  • Fax:
Mailing address:
  • Phone: 901-516-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number907946
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number40385
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: