Basic Information
| Provider Information | |||||||||
| NPI: | 1023143682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUINSEY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 MICCOSUKEE ROAD | ||||||||
| Address2: | HOSPITALIST GROUP | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504314556 | ||||||||
| FaxNumber: | 8504316315 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MICCOSUKEE ROAD | ||||||||
| Address2: | HOSPITALISTS GROUP | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504314556 | ||||||||
| FaxNumber: | 8504316315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 10/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9104064 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1023143682 | 05 | FL | MEDICAID |