Provider Demographics
NPI:1619023199
Name:QUINTANA, JESSIE MARIE (ANPBC)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:MARIE
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:ANPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 N BENITO DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1180
Mailing Address - Country:US
Mailing Address - Phone:719-564-2350
Mailing Address - Fax:719-583-4375
Practice Address - Street 1:151 CENTRAL MAIN ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-4212
Practice Address - Country:US
Practice Address - Phone:719-583-4380
Practice Address - Fax:719-583-4375
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51741363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40551741Medicaid
CO51741OtherRN LICENSE NUMBER
CO51741OtherRN LICENSE NUMBER