Provider Demographics
NPI:1861141343
Name:QUINTAL, BACALL (FNP-C)
Entity type:Individual
Prefix:
First Name:BACALL
Middle Name:
Last Name:QUINTAL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BACALL
Other - Middle Name:
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-778-1620
Mailing Address - Fax:603-772-8015
Practice Address - Street 1:118 PORTSMOUTH AVE BLDG D
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2487
Practice Address - Country:US
Practice Address - Phone:603-778-1620
Practice Address - Fax:603-772-8015
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH079619-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily