Provider Demographics
NPI:1083882617
Name:TRINGALI-HALLIBURTON, DOMENIQUE VANESSA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DOMENIQUE
Middle Name:VANESSA
Last Name:TRINGALI-HALLIBURTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 HOME GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6532
Mailing Address - Country:US
Mailing Address - Phone:586-524-5565
Mailing Address - Fax:
Practice Address - Street 1:2501 N ORANGE AVE STE 235
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4659
Practice Address - Country:US
Practice Address - Phone:407-821-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-17
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004530363A00000X
FL9114212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant