Individual
THERESA M DOMAGOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC, PMHNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
11002747
FL
363LA2100X
Acute Care Nurse Practitioner
430210
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02601196
—
NY
01
—
70008ARA6884
MCR
—
Enumeration date
05/16/2006
Last updated
06/24/2024
Update your record
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