Provider Demographics
NPI:1134146004
Name:MCPHILLIPS, DAMINICA IANDIMARINO (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DAMINICA
Middle Name:IANDIMARINO
Last Name:MCPHILLIPS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 N FEDERAL HWY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1402
Mailing Address - Country:US
Mailing Address - Phone:954-343-5810
Mailing Address - Fax:
Practice Address - Street 1:6451 N FEDERAL HWY
Practice Address - Street 2:SUITE 114
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1402
Practice Address - Country:US
Practice Address - Phone:954-343-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2055162363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2050ZMedicare ID - Type Unspecified