Provider Demographics
NPI:1740155894
Name:QUILES RESEARCH AND MEDICAL GROUP-MEDICAL GROUP LLC
Entity type:Organization
Organization Name:QUILES RESEARCH AND MEDICAL GROUP-MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YANET
Authorized Official - Middle Name:
Authorized Official - Last Name:QUILES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP,PMHNP
Authorized Official - Phone:813-952-3801
Mailing Address - Street 1:11329 CLAYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-1559
Mailing Address - Country:US
Mailing Address - Phone:813-952-3801
Mailing Address - Fax:
Practice Address - Street 1:11329 CLAYRIDGE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-1559
Practice Address - Country:US
Practice Address - Phone:813-952-3801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty