Provider Demographics
NPI:1558973008
Name:QUITASOL, NATHAN (RN)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:QUITASOL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 E SUNDANCE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9480
Mailing Address - Country:US
Mailing Address - Phone:480-650-8373
Mailing Address - Fax:
Practice Address - Street 1:1305 N MARTIN AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-9480
Practice Address - Country:US
Practice Address - Phone:480-650-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ236539163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine