Provider Demographics
NPI:1326442997
Name:QUON, TINA G (ACNP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:G
Last Name:QUON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 MANDANA BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1822
Mailing Address - Country:US
Mailing Address - Phone:415-860-6566
Mailing Address - Fax:209-740-4313
Practice Address - Street 1:1109 MANDANA BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1822
Practice Address - Country:US
Practice Address - Phone:415-860-6566
Practice Address - Fax:209-740-4313
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001508363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care