Provider Demographics
NPI:1346852274
Name:MCQUAGGE, ELIZABETH KEENAN (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KEENAN
Last Name:MCQUAGGE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:400 COLONNADE DR STE 160
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-6236
Practice Address - Country:US
Practice Address - Phone:904-824-1020
Practice Address - Fax:904-391-7503
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO995666363L00000X
FLAPRN11014679363LF0000X, 363L00000X
FL11014679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily