Basic Information
| Provider Information | |||||||||
| NPI: | 1235542713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'QUINN | ||||||||
| FirstName: | TESSIE | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 ANNADALE ST | ||||||||
| Address2: | |||||||||
| City: | DAUPHIN ISLAND | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365284516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2518612305 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MEMORIAL HOSPITAL DR STE 1A | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513436848 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2014 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-107396 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 1-107396 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 102I508593 | 01 | AL | MEDICARE | OTHER | P01369519 | 01 | AL | RR MEDICARE | OTHER |