Provider Demographics
NPI:1710049333
Name:QUINTANILLA, ANGELA CATHERINE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CATHERINE
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 S CEDAR ST
Mailing Address - Street 2:STE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2318
Mailing Address - Country:US
Mailing Address - Phone:253-284-9231
Mailing Address - Fax:253-284-9241
Practice Address - Street 1:2202 S CEDAR ST
Practice Address - Street 2:SUITE 150
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2318
Practice Address - Country:US
Practice Address - Phone:253-830-5432
Practice Address - Fax:253-830-5433
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005547367500000X
GARN198128367500000X
FLARNP9340888367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8913836OtherMDCR PTAN (K)
WAG8919205OtherMDCR PTAN (P)
FLGJ706ZMedicare PIN
WAG8905873Medicare PIN
WAG8942349Medicare PIN