Provider Demographics
NPI:1306387204
Name:QUINTANILLA, BLANCA CELINA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:CELINA
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4001
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-4001
Mailing Address - Country:US
Mailing Address - Phone:936-291-3219
Mailing Address - Fax:
Practice Address - Street 1:125 MEDICAL PARK LN STE C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4957
Practice Address - Country:US
Practice Address - Phone:936-291-3219
Practice Address - Fax:936-291-7206
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1165332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020657400Medicaid
FLAPRN9217454OtherAPRN