Provider Demographics
NPI:1043795909
Name:LINNIK, DARINA (PA-C)
Entity Type:Individual
Prefix:
First Name:DARINA
Middle Name:
Last Name:LINNIK
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 1:1200 SAN LUIS ST
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5579
Mailing Address - Country:US
Mailing Address - Phone:505-401-0537
Mailing Address - Fax:
Practice Address - Street 1:1631 HOSPITAL DR STE 240
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7691
Practice Address - Country:US
Practice Address - Phone:505-913-3975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2018-0065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty