Provider Demographics
NPI:1609236447
Name:QUARTERMAN, KEANDRA
Entity Type:Individual
Prefix:
First Name:KEANDRA
Middle Name:
Last Name:QUARTERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 NE 8TH AVE APT A12
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-4719
Mailing Address - Country:US
Mailing Address - Phone:305-647-8028
Mailing Address - Fax:
Practice Address - Street 1:1733 NE 8TH AVE APT A12
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-4719
Practice Address - Country:US
Practice Address - Phone:305-647-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health