Provider Demographics
NPI:1396077301
Name:QUINN BERGIN, MARY C (RN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:QUINN BERGIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TECHNOLOGY PARK
Mailing Address - Street 2:SUITE 155
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6297
Mailing Address - Country:US
Mailing Address - Phone:877-453-4566
Mailing Address - Fax:866-537-0877
Practice Address - Street 1:100 TECHNOLOGY PARK
Practice Address - Street 2:SUITE 155
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6297
Practice Address - Country:US
Practice Address - Phone:877-453-4566
Practice Address - Fax:866-537-0877
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9241261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse