Individual
MS. NICOLE A. DOMENECH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD.
Contact information
Practice address
950 FIRST ST. SOUTH, WINTER HAVEN, FL 33880
(863) 295-5604
(863) 295-5398
Mailing address
2600 S DOUGLAS RD, STE 308, CORAL GABLES, FL 33134-6134
(863) 682-0843
(863) 687-3971
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
19178
PR
Other
Enumeration date
09/16/2015
Last updated
06/22/2018
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