Provider Demographics
NPI:1629650726
Name:QUINTEROS, TATIHANA (RN)
Entity Type:Individual
Prefix:
First Name:TATIHANA
Middle Name:
Last Name:QUINTEROS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12965 DEXTER ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2203
Mailing Address - Country:US
Mailing Address - Phone:720-401-2896
Mailing Address - Fax:
Practice Address - Street 1:12965 DEXTER ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2203
Practice Address - Country:US
Practice Address - Phone:720-401-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1658470163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty