Provider Demographics
NPI:1720639941
Name:QUINONES, STACEY MARIE (MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:MARIE
Last Name:QUINONES
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 USS NEW MEXICO CT APT 3
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-5044
Mailing Address - Country:US
Mailing Address - Phone:347-513-1341
Mailing Address - Fax:
Practice Address - Street 1:3400 BAINBRIDGE AVE FL MAP7
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-2626
Practice Address - Fax:718-652-1833
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily