Jason Grant Quallich, ARNP | |
3841 Brickway Blvd, Santa Rosa, CA 95403-8226 | |
(727) 515-9490 | |
Not Available |
Full Name | Jason Grant Quallich |
---|---|
Gender | Male |
Speciality | Nurse Practitioner - Family |
Location | 3841 Brickway Blvd, Santa Rosa, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1427349380 | NPI | - | NPPES |
003541900 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | ARNP9229231 (Florida) | Secondary |
363LF0000X | Nurse Practitioner - Family | 95023490 (California) | Primary |
Entity Name | Mobile Visiting Practitioners, Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1265915359 PECOS PAC ID: 7810239100 Enrollment ID: O20190507002879 |
Mailing Address | Practice Location Address |
---|---|
Jason Grant Quallich, ARNP 3654 Alta Vista Ave, Santa Rosa, CA 95409-4049 Ph: (727) 515-9490 | Jason Grant Quallich, ARNP 3841 Brickway Blvd, Santa Rosa, CA 95403-8226 Ph: (727) 515-9490 |
Peggy Walsh Goebel, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 50 Montgomery Dr, Santa Rosa, CA 95404 Phone: 707-585-7780 Fax: 707-585-7784 | |
Julie Barlow, N.P. Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1165 Montgomery Dr, Santa Rosa, CA 95405 Phone: 707-525-5207 | |
Suzanne Watts Dedmore, RN, FNP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1110 N Dutton Ave, Santa Rosa, CA 95401 Phone: 707-303-3600 | |
Amada Ligia Gomez, NURSE PRACTITIONER Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1989 Citrine Way, Santa Rosa, CA 95404 Phone: 786-385-4492 | |
Genesis Callejas-mir, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1501 Mendocino Ave, Santa Rosa, CA 95401 Phone: 707-527-4445 | |
Felipa Jones, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 3317 Chanate Rd, Suite 2c, Santa Rosa, CA 95404 Phone: 707-570-1130 Fax: 707-571-2478 | |
Cynthia R. Ingels, MSN,N.P. Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 500 Doyle Park Dr, Suite 103, Santa Rosa, CA 95405 Phone: 707-579-1102 |