Healthcare Provider Details

I. General information

NPI: 1417653023
Provider Name (Legal Business Name): BRIDGET SALINA QUINTANILLA FNP-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 S 250 W STE 503
ST GEORGE UT
84770-7190
US

IV. Provider business mailing address

1173 S 250 W STE 503
ST GEORGE UT
84770-7190
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-0217
  • Fax:
Mailing address:
  • Phone: 435-674-0217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5252020-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5252020-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: