Individual
STACY LEE QUINNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
212 N WILSON ST, CRESTVIEW, FL 32536-3438
(850) 306-3003
Mailing address
212 N WILSON ST, CRESTVIEW, FL 32536-3438
(850) 306-3003
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
5195867
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5195867
DEPARTMENT OF HEALTH
FL
Enumeration date
03/31/2021
Last updated
03/31/2021
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