Provider Demographics
NPI:1235843079
Name:JENNA QUELLER MD PA
Entity Type:Organization
Organization Name:JENNA QUELLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:NATALIE
Authorized Official - Last Name:QUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-783-3376
Mailing Address - Street 1:3179 SAINT ANNES DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2517
Mailing Address - Country:US
Mailing Address - Phone:561-560-8790
Mailing Address - Fax:
Practice Address - Street 1:7000 W PALMETTO PARK RD STE 105
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3429
Practice Address - Country:US
Practice Address - Phone:561-783-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty