Provider Demographics
NPI:1932534823
Name:SKINNER, QUAWENDELLA BAEJUHNE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:QUAWENDELLA
Middle Name:BAEJUHNE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9570 REGENCY SQUARE BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-9103
Mailing Address - Country:US
Mailing Address - Phone:904-474-9766
Mailing Address - Fax:
Practice Address - Street 1:9570 REGENCY SQUARE BLVD STE 403
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-9103
Practice Address - Country:US
Practice Address - Phone:904-239-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9258252163W00000X
FL11011586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse