Provider Demographics
NPI:1780730770
Name:MOCZYGEMBA, DARYL RAY (MSN, RN, CPNP)
Entity type:Individual
Prefix:MR
First Name:DARYL
Middle Name:RAY
Last Name:MOCZYGEMBA
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Gender:M
Credentials:MSN, RN, CPNP
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Mailing Address - Street 1:1301 BARBARA JORDAN BLVD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3077
Mailing Address - Country:US
Mailing Address - Phone:512-628-1900
Mailing Address - Fax:512-628-1901
Practice Address - Street 1:1301 BARBARA JORDAN BLVD
Practice Address - Street 2:SUITE #401
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3077
Practice Address - Country:US
Practice Address - Phone:512-628-1900
Practice Address - Fax:512-628-1901
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-04-08
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Provider Licenses
StateLicense IDTaxonomies
TX619203363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195759905Medicaid
TXTXB150034Medicare PIN