Provider Demographics
NPI:1215394630
Name:QUIRK, PAMELA (NP - ADULT-GERO)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:QUIRK
Suffix:
Gender:F
Credentials:NP - ADULT-GERO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07756-1669
Mailing Address - Country:US
Mailing Address - Phone:732-776-5458
Mailing Address - Fax:732-776-7065
Practice Address - Street 1:21 MAIN AVE
Practice Address - Street 2:
Practice Address - City:OCEAN GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07756-1669
Practice Address - Country:US
Practice Address - Phone:732-776-5458
Practice Address - Fax:732-776-7065
Is Sole Proprietor?:No
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00607500363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology