Provider Demographics
NPI:1285256628
Name:TOLBERT, DARRYL ANTHONY
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:ANTHONY
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 SESSIONS DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-8707
Mailing Address - Country:US
Mailing Address - Phone:313-330-9940
Mailing Address - Fax:
Practice Address - Street 1:1220 SESSIONS DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-8707
Practice Address - Country:US
Practice Address - Phone:313-330-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.0020271367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered