Provider Demographics
NPI:1013622836
Name:QUINONES JIMENEZ, MAILIN ISABEL (APRN)
Entity Type:Individual
Prefix:
First Name:MAILIN
Middle Name:ISABEL
Last Name:QUINONES JIMENEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-6332
Mailing Address - Country:US
Mailing Address - Phone:786-501-3043
Mailing Address - Fax:
Practice Address - Street 1:2420 W PIERCE ST STE 101
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3517
Practice Address - Country:US
Practice Address - Phone:575-628-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023307207Q00000X, 363LF0000X
NM71568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine