Provider Demographics
NPI:1184809667
Name:DOMINGUEZ, JESSICA L (DNP, ARNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, AG-ACNP
Mailing Address - Street 1:5236 W UNIVERSITY DR STE 2000
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-8112
Mailing Address - Country:US
Mailing Address - Phone:469-800-5215
Mailing Address - Fax:
Practice Address - Street 1:5236 W UNIVERSITY DR STE 2000
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-8112
Practice Address - Country:US
Practice Address - Phone:469-800-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010726363LA2100X
NC285301163W00000X
NC5008783363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse