Provider Demographics
NPI:1326557240
Name:QUIROS, JASON R (FNP-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:QUIROS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:ROBERT
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:12100 SUMMERGATE CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8032
Mailing Address - Country:US
Mailing Address - Phone:789-514-1914
Mailing Address - Fax:
Practice Address - Street 1:1715 N WEST SHORE BLVD STE 920
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3916
Practice Address - Country:US
Practice Address - Phone:561-418-3262
Practice Address - Fax:561-526-8021
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2291841163W00000X
CARN95139213163W00000X
CANP95007565363L00000X
FLAPRN11015460363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse