Provider Demographics
NPI:1811180912
Name:TOLLETT, DARNELL VICTORIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:DARNELL
Middle Name:VICTORIA
Last Name:TOLLETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-0729
Mailing Address - Country:US
Mailing Address - Phone:812-482-2233
Mailing Address - Fax:
Practice Address - Street 1:607 3RD AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3636
Practice Address - Country:US
Practice Address - Phone:812-482-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000939A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner