Provider Demographics
NPI:1093040776
Name:DARWISH, STACY LYN (RN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYN
Last Name:DARWISH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 KNOX ST APT B
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5073
Mailing Address - Country:US
Mailing Address - Phone:949-499-1311
Mailing Address - Fax:
Practice Address - Street 1:220 KNOX ST APT B
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5073
Practice Address - Country:US
Practice Address - Phone:949-244-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA745996163W00000X
CA95021658363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse