Provider Demographics
NPI:1306534458
Name:QUINTANILLA, MATIAS MIGUEL (MSN APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:MATIAS
Middle Name:MIGUEL
Last Name:QUINTANILLA
Suffix:
Gender:M
Credentials:MSN APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:
Practice Address - Street 1:786 W PIONEER BLVD STE A
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8862
Practice Address - Country:US
Practice Address - Phone:702-345-5000
Practice Address - Fax:702-345-2000
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11475617-4408207Q00000X
UT11475617-3102207Q00000X
UT11475617-4405363LF0000X
NV841346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1306534458Medicaid
NV841346OtherSTATE LICENSE