Provider Demographics
NPI:1447768163
Name:DOMINGUEZ, SAHARA PATRICIA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:SAHARA
Middle Name:PATRICIA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-2306
Mailing Address - Country:US
Mailing Address - Phone:434-947-5967
Mailing Address - Fax:
Practice Address - Street 1:320 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-2306
Practice Address - Country:US
Practice Address - Phone:434-947-5967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181043363LF0000X
VA0024175738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily