Provider Demographics
NPI:1134180847
Name:QUINN-CONDON, COLLEEN ELIZABETH (MS, APRN-BC)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:QUINN-CONDON
Suffix:
Gender:F
Credentials:MS, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:79 MIDDLEVILLE RD
Mailing Address - Street 2:116A
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2200
Mailing Address - Country:US
Mailing Address - Phone:631-261-4400
Mailing Address - Fax:631-754-9350
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:116A
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2200
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-754-9350
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF400366363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health