Provider Demographics
NPI:1134868797
Name:GILLESPIE, DOMINIQUE SIERRA (MSN, CRNP, WHNP-BC)
Entity type:Individual
Prefix:MISS
First Name:DOMINIQUE
Middle Name:SIERRA
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MSN, CRNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 N STATE ROAD 7 APT 7302
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2890
Mailing Address - Country:US
Mailing Address - Phone:205-246-1833
Mailing Address - Fax:
Practice Address - Street 1:6401 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1427
Practice Address - Country:US
Practice Address - Phone:954-776-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-165020363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health