Healthcare Provider Details

I. General information

NPI: 1811180912
Provider Name (Legal Business Name): DARNELL VICTORIA TOLLETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 3RD AVE
JASPER IN
47546-3636
US

IV. Provider business mailing address

PO BOX 729
JASPER IN
47547-0729
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-2233
  • Fax:
Mailing address:
  • Phone: 812-482-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000939A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: