Individual
MRS. JENNIFER HOLLY DOMENICO-BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
701 24TH ST, GOLDEN, CO 80401-2379
(303) 360-6276
Mailing address
3701 S BROADWAY, ENGLEWOOD, CO 80113-3611
(303) 360-6276
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.0112072
CO
2255A2300X
Athletic Trainer
AT.0000841
CO
363LF0000X
Family Nurse Practitioner
Primary
APN.0003864-NP
CO
Other
Enumeration date
05/01/2007
Last updated
09/06/2019
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