Provider Demographics
NPI:1326192717
Name:QUINONES-BRAVO, JANICE DAGMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:DAGMAR
Last Name:QUINONES-BRAVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6788
Mailing Address - Country:US
Mailing Address - Phone:727-861-5250
Mailing Address - Fax:
Practice Address - Street 1:7509 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6788
Practice Address - Country:US
Practice Address - Phone:727-861-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13871208D00000X
FLME138745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020710Medicare ID - Type Unspecified
PRH68427Medicare UPIN