Provider Demographics
NPI:1215383039
Name:DOMINGUEZ HERNANDEZ, YUSIMI (ARNP)
Entity Type:Individual
Prefix:
First Name:YUSIMI
Middle Name:
Last Name:DOMINGUEZ HERNANDEZ
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 1:4610 WEYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-2252
Mailing Address - Country:US
Mailing Address - Phone:786-468-0397
Mailing Address - Fax:
Practice Address - Street 1:40 S MAIN ST STE 1300
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-5513
Practice Address - Country:US
Practice Address - Phone:786-468-0397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9320756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily