Provider Demographics
NPI:1053079590
Name:RAMIREZ, DOMENICA MARIELA
Entity Type:Individual
Prefix:
First Name:DOMENICA
Middle Name:MARIELA
Last Name:RAMIREZ
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 1:12201 RESEARCH PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3265
Mailing Address - Country:US
Mailing Address - Phone:407-823-2744
Mailing Address - Fax:
Practice Address - Street 1:12201 RESEARCH PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3265
Practice Address - Country:US
Practice Address - Phone:407-823-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11025227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily