Provider Demographics
NPI:1114115862
Name:DARLING, ELIZABETH LEEANNE (PA-C MPAS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEEANNE
Last Name:DARLING
Suffix:
Gender:F
Credentials:PA-C MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 HIGHLAND DR
Mailing Address - Street 2:#200
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2670
Mailing Address - Country:US
Mailing Address - Phone:801-993-1800
Mailing Address - Fax:801-993-1699
Practice Address - Street 1:4252 HIGHLAND DR
Practice Address - Street 2:#200
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84124-2670
Practice Address - Country:US
Practice Address - Phone:801-993-1800
Practice Address - Fax:801-993-1699
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6710989-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6710989-1206OtherSTATE LICENSE