Provider Demographics
NPI:1477043016
Name:O'QUIN, COLBY J (PMHNP DNP)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:J
Last Name:O'QUIN
Suffix:
Gender:M
Credentials:PMHNP DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 476 BOX 23
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96322-0001
Mailing Address - Country:US
Mailing Address - Phone:315-252-2278
Mailing Address - Fax:
Practice Address - Street 1:857-0056
Practice Address - Street 2:
Practice Address - City:HIRASEMACHI
Practice Address - State:NAGASAKI
Practice Address - Zip Code:96322
Practice Address - Country:JP
Practice Address - Phone:315-225-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IAG155452363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program