Healthcare Provider Details

I. General information

NPI: 1144267642
Provider Name (Legal Business Name): DARLENE MCMIDDLETON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 4TH AVE
SAN DIEGO CA
92101-2394
US

IV. Provider business mailing address

1963 4TH AVE
SAN DIEGO CA
92101-2394
US

V. Phone/Fax

Practice location:
  • Phone: 619-275-0822
  • Fax: 619-275-5069
Mailing address:
  • Phone: 619-233-3432
  • Fax: 619-275-5069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number50-03922
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number95003647
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95003647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: