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General NPI Number Information
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NPI Number | 1689177503
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Entity Type | Organization
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Legal Business Name | QUICKCARENP
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 719 HIGH ST
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City | PORTSMOUTH
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State | VA
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Zip | 23704-3425
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Country | US
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Telephone | 757-330-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 49 PROSPECT PKWY
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City | PORTSMOUTH
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State | VA
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Zip | 23702-2831
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Country | US
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Telephone | 224-578-3182
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | MRS. AUTUM FABRE SIMMONS
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Credential | FNP
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Telephone | 757-330-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024175436
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License Number State | VA
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