Provider Demographics
NPI:1366828568
Name:QUINN, HOLLY (FNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WATERMILL WAY
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-1721
Mailing Address - Country:US
Mailing Address - Phone:631-594-1228
Mailing Address - Fax:
Practice Address - Street 1:16 WATERMILL WAY
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-1721
Practice Address - Country:US
Practice Address - Phone:631-594-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339848-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily