Provider Demographics
NPI:1750448387
Name:FRANKLIN, TEQUILA QUINTANA (RN)
Entity Type:Individual
Prefix:MRS
First Name:TEQUILA
Middle Name:QUINTANA
Last Name:FRANKLIN
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 1:5927 DUNHAM RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-4053
Mailing Address - Country:US
Mailing Address - Phone:216-663-4528
Mailing Address - Fax:216-663-4528
Practice Address - Street 1:5927 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-4053
Practice Address - Country:US
Practice Address - Phone:216-663-4528
Practice Address - Fax:216-663-4528
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH409941163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2222884Medicaid