Provider Demographics
NPI:1366028771
Name:DOMINIC, JUNAINA ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:JUNAINA
Middle Name:ROSE
Last Name:DOMINIC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0926
Mailing Address - Country:US
Mailing Address - Phone:352-732-3005
Mailing Address - Fax:352-732-4860
Practice Address - Street 1:1040 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0926
Practice Address - Country:US
Practice Address - Phone:352-732-3005
Practice Address - Fax:352-732-4860
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113621363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant