Provider Demographics
NPI:1366768079
Name:QUINN, JENNIFER MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:QUINN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:FELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1115 W RANDOL MILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2577
Mailing Address - Country:US
Mailing Address - Phone:817-303-6647
Mailing Address - Fax:817-303-6651
Practice Address - Street 1:2485 E SOUTHLAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6687
Practice Address - Country:US
Practice Address - Phone:817-303-6647
Practice Address - Fax:817-303-6651
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06712363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant