Provider Demographics
NPI:1831502855
Name:QUINTANA, ERNESTO ENRIQUE SR (RN / CDE)
Entity type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:ENRIQUE
Last Name:QUINTANA
Suffix:SR
Gender:M
Credentials:RN / CDE
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Mailing Address - Street 1:1301 NE MIAMI GARDENS DR APT 1104
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4997
Mailing Address - Country:US
Mailing Address - Phone:305-803-7640
Mailing Address - Fax:305-949-7250
Practice Address - Street 1:1648 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4731
Practice Address - Country:US
Practice Address - Phone:305-949-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN9248795163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator