MEDICARE: GLORIA JEAN QUINN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA01632	TX

General Provider Information

NPI Number	:	1184755985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA JEAN QUINN PA

Provider Business Mailing Address
First Line	:	524 PAUL JONES PASS
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-2924
Country	:	US
Telephone Number	:	512-292-3535
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 PAUL JONES PASS
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-2924
Country	:	US
Telephone Number	:	512-292-3535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	04/07/2016

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