Provider Demographics
NPI:1417439423
Name:MATIK, DARREN RUSSELL (RN, NP, PHN)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:RUSSELL
Last Name:MATIK
Suffix:
Gender:M
Credentials:RN, NP, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33292 LA COLINA DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93265-9617
Mailing Address - Country:US
Mailing Address - Phone:559-202-7710
Mailing Address - Fax:
Practice Address - Street 1:36650 ROAD 112
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-9517
Practice Address - Country:US
Practice Address - Phone:559-735-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95009207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily