Provider Demographics
NPI:1730289844
Name:QUICCI, JENNIFER KAY (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:QUICCI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KAY
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:840 OLD MILL DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8077
Mailing Address - Country:US
Mailing Address - Phone:313-580-2791
Mailing Address - Fax:
Practice Address - Street 1:2000 JOSEPH E SANKER BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212
Practice Address - Country:US
Practice Address - Phone:513-204-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704181425367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104489811Medicaid
MIJC181425OtherBLUE CROSS OF MI
MI104489811Medicaid
MIJC181425OtherBLUE CROSS OF MI