Provider Demographics
NPI:1780650846
Name:STANGE, DARRELL (FNP)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:STANGE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 COMMERCE ST
Mailing Address - Street 2:STE. 700
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1826
Mailing Address - Country:US
Mailing Address - Phone:615-913-5086
Mailing Address - Fax:888-494-2588
Practice Address - Street 1:2425 WEST LOOP S STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-4208
Practice Address - Country:US
Practice Address - Phone:956-278-3361
Practice Address - Fax:855-597-6536
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX252883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS92498Medicare UPIN
TX8D1651Medicare PIN