Provider Demographics
NPI:1033534805
Name:JARVIS, DERRIN E (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DERRIN
Middle Name:E
Last Name:JARVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5775
Practice Address - Street 1:75 PRINGLE WAY STE 706
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1472
Practice Address - Country:US
Practice Address - Phone:775-982-5770
Practice Address - Fax:775-982-5775
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA3014363AS0400X
MAPA4976363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV12791220OtherCAQH
NVPA3014OtherNV LICENSE