=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346921103
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUINN CAMERON TAYLOR DNP, ARNP, CPNP-PC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2023
-----------------------------------------------------
Last Update Date | 09/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 S L ST FL 2
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98405-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-905-5178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4435 N 7TH ST
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98406-3507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-905-5178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | AP61546024
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Registered Nurse
-----------------------------------------------------
License Number | RN60402361
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------