Provider Demographics
NPI:1790216547
Name:DARILEK, JENNA DENISE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:DENISE
Last Name:DARILEK
Suffix:
Gender:F
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 1:2705 HOSPITAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5776
Mailing Address - Country:US
Mailing Address - Phone:361-579-4705
Mailing Address - Fax:361-579-4755
Practice Address - Street 1:2705 HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5776
Practice Address - Country:US
Practice Address - Phone:361-579-4705
Practice Address - Fax:361-579-4755
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant