Provider Demographics
NPI:1457507188
Name:QUINONES, VICTOR D (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:D
Last Name:QUINONES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 CORD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-480-2548
Practice Address - Street 1:3720 CORD AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-8061
Practice Address - Country:US
Practice Address - Phone:407-414-0866
Practice Address - Fax:407-480-2548
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant