Healthcare Provider Details

I. General information

NPI: 1639717093
Provider Name (Legal Business Name): QUIN SWEENEY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 05/17/2023
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 ST FRANCIS BLVD STE 200
MIDLOTHIAN VA
23114-3206
US

IV. Provider business mailing address

13801 ST FRANCIS BLVD
MIDLOTHIAN VA
23114-3206
US

V. Phone/Fax

Practice location:
  • Phone: 804-379-2414
  • Fax:
Mailing address:
  • Phone: 804-379-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178067
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: