Provider Demographics
NPI:1003839580
Name:QUILLEN, STACI M (FNP)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:M
Last Name:QUILLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MCFARLAND ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3992
Mailing Address - Country:US
Mailing Address - Phone:423-587-0860
Mailing Address - Fax:423-586-1027
Practice Address - Street 1:500 MCFARLAND ST
Practice Address - Street 2:SUITE E
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3992
Practice Address - Country:US
Practice Address - Phone:423-587-0860
Practice Address - Fax:423-586-1027
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN31597547OtherBCBS
TN31597547OtherBCBS
TN3906816Medicare ID - Type Unspecified