Provider Demographics
NPI:1568927648
Name:QUINONES, JORGE (APRN)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:QUINONES
Suffix:
Gender:M
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:MILLENNIUM PHYSICIAN GROUP, LLC
Mailing Address - Street 2:2675 WINKLER AVENUE, SECOND FLOOR
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:11181 HEALTH PARK BLVD STE 3010
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5743
Practice Address - Country:US
Practice Address - Phone:239-302-3290
Practice Address - Fax:239-302-3291
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001273363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11001273OtherLICENSE NUMBER