Provider Demographics
NPI:1174813323
Name:QUINN, JADA C (DNP)
Entity type:Individual
Prefix:MRS
First Name:JADA
Middle Name:C
Last Name:QUINN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4100 N MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5800
Mailing Address - Country:US
Mailing Address - Phone:803-786-1795
Mailing Address - Fax:803-786-6452
Practice Address - Street 1:4100 N MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5800
Practice Address - Country:US
Practice Address - Phone:803-786-1795
Practice Address - Fax:803-786-6452
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2013-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC4132363LP2300X, 363LA2100X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA82077370OtherMEDICARE PTAN