Provider Demographics
NPI:1255677480
Name:RAPPA, DOMENICA (RN, FNP)
Entity Type:Individual
Prefix:
First Name:DOMENICA
Middle Name:
Last Name:RAPPA
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MATHER HOSPITAL
Practice Address - Street 2:75 N COUNTRY ROAD
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-473-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-16
Last Update Date:2023-03-23
Deactivation Date:2016-06-07
Deactivation Code:
Reactivation Date:2019-06-27
Provider Licenses
StateLicense IDTaxonomies
NY645874163W00000X
NY344016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse