Provider Demographics
NPI:1841763596
Name:HAMMOCK, DOMONIQUE YOLANDA (FNP)
Entity Type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:YOLANDA
Last Name:HAMMOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DOMONIQUE
Other - Middle Name:YOLANDA
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5905 US HIGHWAY 301 S
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5905 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3800
Practice Address - Country:US
Practice Address - Phone:727-822-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000436363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily