Provider Demographics
NPI:1326704230
Name:DOMINGUEZ, DEVIN DIOGENES (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:DIOGENES
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 MEASE DR STE 307
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6605
Mailing Address - Country:US
Mailing Address - Phone:727-725-6128
Mailing Address - Fax:727-725-6168
Practice Address - Street 1:1840 MEASE DR STE 307
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6605
Practice Address - Country:US
Practice Address - Phone:727-725-6128
Practice Address - Fax:727-725-6168
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015367363LC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine