Provider Demographics
NPI:1013572536
Name:QUINTANA, DANIELA (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:MARTINOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7400 SW 87TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5458
Practice Address - Country:US
Practice Address - Phone:786-204-4201
Practice Address - Fax:786-591-6001
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9400363A00000X
FLPA9114354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant