Provider Demographics
NPI:1790345437
Name:ROSARIO DOMINGUEZ, TANIA LIZ (NP)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:LIZ
Last Name:ROSARIO DOMINGUEZ
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:28301 SW 157TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1246
Mailing Address - Country:US
Mailing Address - Phone:305-505-3647
Mailing Address - Fax:
Practice Address - Street 1:17591 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5435
Practice Address - Country:US
Practice Address - Phone:305-317-9592
Practice Address - Fax:786-431-2577
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11002763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily