Provider Demographics
NPI:1689252603
Name:QUINNELL, STACY LEE (LPN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LEE
Last Name:QUINNELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N WILSON ST
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-3438
Mailing Address - Country:US
Mailing Address - Phone:850-306-3003
Mailing Address - Fax:
Practice Address - Street 1:212 N WILSON ST
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-3438
Practice Address - Country:US
Practice Address - Phone:850-306-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5195867164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5195867OtherDEPARTMENT OF HEALTH