Provider Demographics
NPI:1053142075
Name:QUINN, MAUREEN K (FNP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:K
Last Name:QUINN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:K
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:128 PARKER AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-8208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:128 PARKER AVE S
Practice Address - Street 2:
Practice Address - City:BROOKLET
Practice Address - State:GA
Practice Address - Zip Code:30415-8208
Practice Address - Country:US
Practice Address - Phone:912-842-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN289407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily