Provider Demographics
NPI:1962136341
Name:DARWICHE, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DARWICHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25880 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-4108
Mailing Address - Country:US
Mailing Address - Phone:313-909-3174
Mailing Address - Fax:
Practice Address - Street 1:1300 E CYPRESS ST BLDG A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4728
Practice Address - Country:US
Practice Address - Phone:805-250-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant