Provider Demographics
NPI:1043622467
Name:QUINTANA, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 NW COUNTY ROAD 235
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-6660
Mailing Address - Country:US
Mailing Address - Phone:352-339-3267
Mailing Address - Fax:386-462-9666
Practice Address - Street 1:10110 NW COUNTY ROAD 235
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615
Practice Address - Country:US
Practice Address - Phone:386-462-7346
Practice Address - Fax:386-462-7381
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9278563363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014839100Medicaid
FLHW477XMedicare PIN