Provider Demographics
NPI:1497936082
Name:TENNANT, QUINTIN DEAN (LVN)
Entity Type:Individual
Prefix:MR
First Name:QUINTIN
Middle Name:DEAN
Last Name:TENNANT
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 ENCHANTE WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5672
Mailing Address - Country:US
Mailing Address - Phone:760-390-3517
Mailing Address - Fax:
Practice Address - Street 1:1312 ENCHANTE WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5672
Practice Address - Country:US
Practice Address - Phone:760-390-3517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-24
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN158149164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse