Provider Demographics
NPI:1215447131
Name:QUAICOE, JAMES (NP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:QUAICOE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FOUNDERS ST
Mailing Address - Street 2:STE 102
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2050
Mailing Address - Country:US
Mailing Address - Phone:508-309-5676
Mailing Address - Fax:
Practice Address - Street 1:29 NARRAGANSETT AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1558
Practice Address - Country:US
Practice Address - Phone:508-309-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8887363LA2200X
MARN2297807363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty