Provider Demographics
NPI:1225502461
Name:QUINT, TY (PA-C)
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:QUINT
Suffix:
Gender:M
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 1:6280 W SAMPLE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3173
Mailing Address - Country:US
Mailing Address - Phone:561-314-7200
Mailing Address - Fax:
Practice Address - Street 1:6280 W SAMPLE RD STE 203
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3173
Practice Address - Country:US
Practice Address - Phone:561-314-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111885363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant