Provider Demographics
NPI:1568469922
Name:BROWN, DARREL JAMES (FNPC)
Entity Type:Individual
Prefix:
First Name:DARREL
Middle Name:JAMES
Last Name:BROWN
Suffix:
Gender:M
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 SAINT GERTRUDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-1924
Mailing Address - Country:US
Mailing Address - Phone:408-489-3638
Mailing Address - Fax:707-374-3148
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571-1619
Practice Address - Country:US
Practice Address - Phone:707-374-3142
Practice Address - Fax:707-374-3148
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP31027Medicare UPIN
CAZZZ20784ZMedicare ID - Type Unspecified