Provider Demographics
NPI:1326635699
Name:DOMINGUEZ, BRITTANY SKYLAR
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:SKYLAR
Last Name:DOMINGUEZ
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 1:2211 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2167
Mailing Address - Country:US
Mailing Address - Phone:850-818-0095
Mailing Address - Fax:850-841-1448
Practice Address - Street 1:2211 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2167
Practice Address - Country:US
Practice Address - Phone:850-818-0095
Practice Address - Fax:850-841-1448
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-24-14975106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst