Provider Demographics
NPI:1467178079
Name:DOMINGO, JA'NERE LENA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JA'NERE
Middle Name:LENA
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6889
Mailing Address - Country:US
Mailing Address - Phone:706-653-6080
Mailing Address - Fax:706-653-6052
Practice Address - Street 1:4215 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6889
Practice Address - Country:US
Practice Address - Phone:706-653-6080
Practice Address - Fax:706-653-6052
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN280061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine