Provider Demographics
NPI:1740287242
Name:QUINN, AGATHA ANNE (PHD, APRN, FNP)
Entity type:Individual
Prefix:MRS
First Name:AGATHA
Middle Name:ANNE
Last Name:QUINN
Suffix:
Gender:F
Credentials:PHD, APRN, FNP
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:A
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, APRN, FNP
Mailing Address - Street 1:6082 S GLENCOE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-3427
Mailing Address - Country:US
Mailing Address - Phone:303-770-1594
Mailing Address - Fax:
Practice Address - Street 1:UCDHSC-SON C-288-5
Practice Address - Street 2:4200 EAST NINTH AVENUE
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80262-0001
Practice Address - Country:US
Practice Address - Phone:303-315-5213
Practice Address - Fax:303-315-0907
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07507577Medicaid
COD7036Medicare ID - Type Unspecified
COP31057Medicare UPIN