Healthcare Provider Details

I. General information

NPI: 1780993162
Provider Name (Legal Business Name): JAMIE CAROL DARK RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12174 N MOPAC EXPY STE. A
AUSTIN TX
78758-2910
US

IV. Provider business mailing address

12174 N MOPAC EXPY STE. A
AUSTIN TX
78758-2910
US

V. Phone/Fax

Practice location:
  • Phone: 512-833-7334
  • Fax: 512-833-7333
Mailing address:
  • Phone: 512-833-7334
  • Fax: 512-833-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number734374
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: