Provider Demographics
NPI:1033260724
Name:QUINN, ALLAN (CRNA)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-0789
Mailing Address - Country:US
Mailing Address - Phone:228-818-0563
Mailing Address - Fax:228-818-0519
Practice Address - Street 1:1720B MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2131
Practice Address - Country:US
Practice Address - Phone:678-553-8150
Practice Address - Fax:678-553-8152
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS132640367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015780Medicaid
MS09015780Medicaid