Provider Demographics
NPI:1245900471
Name:QUAGLINO, JILL ROSE (FNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ROSE
Last Name:QUAGLINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 MAIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2893
Mailing Address - Country:US
Mailing Address - Phone:845-797-1823
Mailing Address - Fax:
Practice Address - Street 1:192 MAIN ST APT 1
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2893
Practice Address - Country:US
Practice Address - Phone:845-797-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily