Provider Demographics
NPI:1841763596
Name:HAMMOCK, DOMONIQUE YOLANDA (FNP)
Entity type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:YOLANDA
Last Name:HAMMOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DOMONIQUE
Other - Middle Name:YOLANDA
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:2470 BLOOMINGDALE AVE STE 260
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6403
Practice Address - Country:US
Practice Address - Phone:813-725-7220
Practice Address - Fax:813-725-7221
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000436363LF0000X
FL11000436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily