Provider Demographics
NPI:1235542713
Name:O'QUINN, TESSIE (FNP-BC; AGACNP-C)
Entity Type:Individual
Prefix:
First Name:TESSIE
Middle Name:
Last Name:O'QUINN
Suffix:
Gender:F
Credentials:FNP-BC; AGACNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 MONBERAUT PL
Mailing Address - Street 2:
Mailing Address - City:DAUPHIN ISLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36528-4310
Mailing Address - Country:US
Mailing Address - Phone:843-425-4818
Mailing Address - Fax:
Practice Address - Street 1:3719 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1753
Practice Address - Country:US
Practice Address - Phone:251-344-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107396363L00000X, 363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP01369519OtherRR MEDICARE
AL102I508593OtherMEDICARE
AL213162Medicaid
AL512-06263OtherBCBS
AL102I508593OtherMEDICARE
AL213260Medicaid
AL223510Medicaid
ALP01369519OtherRR MEDICARE
AL165330Medicaid
AL512-06264OtherBCBS
MS05539059OtherMS MEDICAID
AL4807343OtherAETNA
AL511-95736OtherBCBS
AL5123096OtherUHC