Provider Demographics
NPI:1255207650
Name:BOYKIN, DOMONIQUE LESHAWN
Entity type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:LESHAWN
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:
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 504
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-0504
Mailing Address - Country:US
Mailing Address - Phone:352-256-7717
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 504
Practice Address - Street 2:
Practice Address - City:ARCHER
Practice Address - State:FL
Practice Address - Zip Code:32618-0504
Practice Address - Country:US
Practice Address - Phone:352-256-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach