Provider Demographics
NPI:1720413974
Name:COTTLE, DARRIN JON (PA-C)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:JON
Last Name:COTTLE
Suffix:
Gender:M
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 1:565 KOMAS DR.
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108
Mailing Address - Country:US
Mailing Address - Phone:801-584-5144
Mailing Address - Fax:801-584-5206
Practice Address - Street 1:565 KOMAS DR.
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108
Practice Address - Country:US
Practice Address - Phone:801-584-5144
Practice Address - Fax:801-584-5206
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7428364-4901133V00000X
UT7428364-8906363AM0700X
UT7428364-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical