Healthcare Provider Details

I. General information

NPI: 1093040776
Provider Name (Legal Business Name): STACY LYN DARWISH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 03/15/2023
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 KNOX ST APT B
COSTA MESA CA
92627-5073
US

IV. Provider business mailing address

220 KNOX ST APT B
COSTA MESA CA
92627-5073
US

V. Phone/Fax

Practice location:
  • Phone: 949-244-2955
  • Fax:
Mailing address:
  • Phone: 949-499-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number745996
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: