Provider Demographics
NPI:1871039115
Name:DOMINGUEZ, LEYDI (ARNP)
Entity Type:Individual
Prefix:
First Name:LEYDI
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3592 ALOMA AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4012
Mailing Address - Country:US
Mailing Address - Phone:571-230-3394
Mailing Address - Fax:
Practice Address - Street 1:3592 ALOMA AVE STE 5
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4012
Practice Address - Country:US
Practice Address - Phone:571-230-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9380442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily