Provider Demographics
NPI:1043093230
Name:QUICK, COLLEEN RITA (PA-C)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:RITA
Last Name:QUICK
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 1:2264 KINDLING HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3847
Mailing Address - Country:US
Mailing Address - Phone:757-407-4248
Mailing Address - Fax:
Practice Address - Street 1:2264 KINDLING HOLLOW RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3847
Practice Address - Country:US
Practice Address - Phone:757-407-4248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1210557363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant