Provider Demographics
NPI:1588172969
Name:QUACH, DEANNA (CPNP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:QUACH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 KENWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-3104
Mailing Address - Country:US
Mailing Address - Phone:469-613-2573
Mailing Address - Fax:469-613-2583
Practice Address - Street 1:5404 KENWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3104
Practice Address - Country:US
Practice Address - Phone:469-613-2573
Practice Address - Fax:463-613-2583
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135573363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics