Provider Demographics
NPI:1780993162
Name:DARK, JAMIE CAROL (RN, MSN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:CAROL
Last Name:DARK
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Gender:F
Credentials:RN, MSN, CPNP
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Mailing Address - Street 1:12174 N MOPAC EXPY
Mailing Address - Street 2:STE. A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2910
Mailing Address - Country:US
Mailing Address - Phone:512-833-7334
Mailing Address - Fax:512-833-7333
Practice Address - Street 1:12174 N MOPAC EXPY
Practice Address - Street 2:STE. A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2910
Practice Address - Country:US
Practice Address - Phone:512-833-7334
Practice Address - Fax:512-833-7333
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX734374363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics