Provider Demographics
NPI:1942985007
Name:SALAZAR DOMINGUEZ, IDALBERTO SR (MSN,APRN,FNP-C)
Entity Type:Individual
Prefix:
First Name:IDALBERTO
Middle Name:
Last Name:SALAZAR DOMINGUEZ
Suffix:SR
Gender:M
Credentials:MSN,APRN,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:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-216-0072
Mailing Address - Fax:877-807-0253
Practice Address - Street 1:1411 SE 16TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3818
Practice Address - Country:US
Practice Address - Phone:239-673-6516
Practice Address - Fax:239-673-6536
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily