Provider Demographics
NPI:1386257046
Name:HINES, DARYL JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:JEAN
Last Name:HINES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DARYL
Other - Middle Name:JEAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7706 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1317
Mailing Address - Country:US
Mailing Address - Phone:614-436-8888
Mailing Address - Fax:614-413-3094
Practice Address - Street 1:7706 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1317
Practice Address - Country:US
Practice Address - Phone:614-436-8888
Practice Address - Fax:614-413-3094
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant