1730535329 NPI number — MISS QUENNIE XSERENITY MSN, RN

Table of content: MISS QUENNIE XSERENITY MSN, RN (NPI 1730535329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730535329 NPI number — MISS QUENNIE XSERENITY MSN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
XSERENITY
Provider First Name:
QUENNIE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BONNEY
Provider Other First Name:
QUENNIE
Provider Other Middle Name:
LANADA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730535329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6555 MEMPHIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32526-9077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-285-9872
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3224 MARINERS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32526-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-281-5443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN9469399 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN79501 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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