Provider Demographics
NPI:1467974097
Name:DOMINGUEZ, CHRISTINE ALICE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ALICE
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 1:7385 SALMON LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5527
Mailing Address - Country:US
Mailing Address - Phone:912-399-4832
Mailing Address - Fax:
Practice Address - Street 1:1000 E 3RD ST STE 201
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2159
Practice Address - Country:US
Practice Address - Phone:423-778-2867
Practice Address - Fax:423-778-2866
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN22755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily