Provider Demographics
NPI:1669021382
Name:DOMINGUEZ, ANITA MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MICHELLE
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:MICHELLE
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13915 BURNET RD STE 303
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6505
Mailing Address - Country:US
Mailing Address - Phone:512-269-5425
Mailing Address - Fax:512-996-9905
Practice Address - Street 1:13915 BURNET RD STE 303
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6505
Practice Address - Country:US
Practice Address - Phone:512-269-5425
Practice Address - Fax:512-996-9905
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX839522163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health