Provider Demographics
NPI:1902416555
Name:DOMINGUEZ, ANA MARIA (APRN)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 S DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5304
Mailing Address - Country:US
Mailing Address - Phone:305-440-5969
Mailing Address - Fax:305-476-9441
Practice Address - Street 1:5235 SW 99TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7136
Practice Address - Country:US
Practice Address - Phone:786-477-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty