Provider Demographics
NPI:1851664445
Name:MCQUIGG, LESLI G (ANP-BC)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:G
Last Name:MCQUIGG
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 SHRINE RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4784
Mailing Address - Country:US
Mailing Address - Phone:912-466-7250
Mailing Address - Fax:912-466-7253
Practice Address - Street 1:3025 SHRINE RD
Practice Address - Street 2:SUITE 190
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4784
Practice Address - Country:US
Practice Address - Phone:912-466-7250
Practice Address - Fax:912-466-7253
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN130343363LW0102X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN130343OtherLICENSE NUMBER