Provider Demographics
NPI:1972964252
Name:DURGIN, DARRON JACKSON (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:DARRON
Middle Name:JACKSON
Last Name:DURGIN
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 S LATUS PL
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6432
Mailing Address - Country:US
Mailing Address - Phone:714-935-8158
Mailing Address - Fax:714-935-6020
Practice Address - Street 1:1727 S LATUS PL
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-6432
Practice Address - Country:US
Practice Address - Phone:714-935-8158
Practice Address - Fax:714-935-6020
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571801163WA2000X, 163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator