Provider Demographics
NPI:1952334104
Name:WESTERGAARD, DOMONIC LANE (APRN, MSN, PPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DOMONIC
Middle Name:LANE
Last Name:WESTERGAARD
Suffix:
Gender:F
Credentials:APRN, MSN, PPCNP-BC
Other - Prefix:MRS
Other - First Name:DOMONIC
Other - Middle Name:LANE
Other - Last Name:HALL-WESTERGAARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, MSN, PPCNP-BC
Mailing Address - Street 1:661 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 217
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5105
Mailing Address - Country:US
Mailing Address - Phone:407-339-3030
Mailing Address - Fax:407-339-3003
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:SUITE 217
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5105
Practice Address - Country:US
Practice Address - Phone:407-339-3030
Practice Address - Fax:407-339-3003
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2708102363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics