Provider Demographics
NPI:1740552850
Name:EARNHARDT, ARYN L (FNP)
Entity type:Individual
Prefix:MRS
First Name:ARYN
Middle Name:L
Last Name:EARNHARDT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ARYN
Other - Middle Name:D
Other - Last Name:LINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3687 MT DIABLO BLVD
Mailing Address - Street 2:#200
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3717
Mailing Address - Country:US
Mailing Address - Phone:510-204-6660
Mailing Address - Fax:
Practice Address - Street 1:2850 TELEGRAPH AVE STE 110
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1159
Practice Address - Country:US
Practice Address - Phone:510-204-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-04
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP21557363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner