Provider Demographics
NPI:1467233668
Name:DOMINGUEZ, DANNA LARAINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DANNA
Middle Name:LARAINE
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 1:6006 ALAMITO ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7807
Mailing Address - Country:US
Mailing Address - Phone:325-245-1902
Mailing Address - Fax:
Practice Address - Street 1:6006 ALAMITO ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7807
Practice Address - Country:US
Practice Address - Phone:325-245-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily