=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831051721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUANTARA CLINICAL & DIAGNOSTIC CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2025
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6300 N WICKHAM RD STE 103-526
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-400-8871
-----------------------------------------------------
Fax | 772-212-8697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6300 N WICKHAM RD STE 103-526
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-400-8871
-----------------------------------------------------
Fax | 772-212-8697
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. JINNAIL SESSIONS-HOUSTON
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 321-400-8871
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------