| Doctor Name: | DENISE QUALLO |
| NPI Number: | 1528477411 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | ARNP 9220628 |
| Business Practice Address: | 2261 Ne 36 St #2 Lighthouse Point, FL - 33064 |
| Business Phone Number: | 9547869552 |
| Business Fax Number: | 9547869557 |
| Mailing Address: | 2261 Ne 36 St #2, LIGHTHOUSE POINT |
| State: | FL |
| Postal Code: | 33064 |
| Phone Number: | 9547869552 |
| Fax Number: | 9547869557 |
| NPI Enumeration Date: | 08/05/2014 |
| NPI Last Update Date: | 08/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP 9220628 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |