Provider Demographics
NPI:1033480835
Name:QUINN, MELANIE ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ROSE
Last Name:QUINN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 ROYAL PALMS CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-7261
Mailing Address - Country:US
Mailing Address - Phone:214-315-3073
Mailing Address - Fax:
Practice Address - Street 1:3929 ROYAL PALMS COURT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244
Practice Address - Country:US
Practice Address - Phone:214-315-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA-00533OtherPA-TSBME LIC #