Provider Demographics
NPI:1811629652
Name:DOMINGUEZ, ANJELICA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANJELICA
Middle Name:
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 1:609 S CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-8721
Mailing Address - Country:US
Mailing Address - Phone:806-803-9486
Mailing Address - Fax:
Practice Address - Street 1:609 S CAROLINA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-8721
Practice Address - Country:US
Practice Address - Phone:806-803-9486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1086335363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner