Provider Demographics
NPI:1689173858
Name:QUINN, SANDRA MICHELE (CRNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MICHELE
Last Name:QUINN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-7307
Mailing Address - Country:US
Mailing Address - Phone:334-714-1053
Mailing Address - Fax:
Practice Address - Street 1:2445 MURPHY MILL RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1595
Practice Address - Country:US
Practice Address - Phone:334-677-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-097557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily