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General NPI Number Information
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NPI Number | 1578652541
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Entity Type | Organization
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Legal Business Name | QOL, LLC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13325 DOWELL RD
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City | SOLOMONS
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State | MD
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Zip | 20688-1509
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Country | US
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Telephone | 410-326-0077
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Fax | 410-326-6296
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Provider Business Mailing Address
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Address Line | PO BOX 214
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City | LUSBY
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State | MD
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Zip | 20657-0214
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Country | US
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Telephone | 410-474-9356
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. TIFFANY GAINES
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Credential | CRNP
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Telephone | 410-474-9356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | W11339405
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License Number State | MD
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