Provider Demographics
NPI:1184656647
Name:QUINONES, GLADYS (APRN)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:QUINONES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 FARMINGTON AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2107
Mailing Address - Country:US
Mailing Address - Phone:860-570-4882
Mailing Address - Fax:860-570-4885
Practice Address - Street 1:1007 FARMINGTON AVE STE 3A
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2107
Practice Address - Country:US
Practice Address - Phone:860-570-4882
Practice Address - Fax:860-570-4885
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002324363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004215316Medicaid
2V8743OtherHEALTHNET
CT400002324CT05OtherANTHEM
CT500001995Medicare PIN
CTP33819Medicare UPIN