Provider Demographics
NPI:1588245435
Name:QUINN, JACQUELINE ANN CHAVEZ (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN CHAVEZ
Last Name:QUINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ANN
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1002 WILLOW DR APT 47
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2936
Mailing Address - Country:US
Mailing Address - Phone:865-684-5474
Mailing Address - Fax:
Practice Address - Street 1:UNC HOSPITALS N2198, CB7010
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-4220
Practice Address - Country:US
Practice Address - Phone:984-974-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CHAV-VXF0L4390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program