Provider Demographics
NPI:1740525161
Name:DAMIANI, DARREN JAMES (FNP-C)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:JAMES
Last Name:DAMIANI
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WILFORD HALL LOOP
Mailing Address - Street 2:SGHC/CREDENTIALS
Mailing Address - City:JBSA-LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:210-292-7749
Mailing Address - Fax:210-292-7964
Practice Address - Street 1:1100 WILFORD HALL LOOP
Practice Address - Street 2:SGHC/CREDENTIALS
Practice Address - City:JBSA-LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-4660
Practice Address - Country:US
Practice Address - Phone:210-292-7749
Practice Address - Fax:210-292-7964
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4056363LF0000X
MNR-141361-2363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily