Individual
DOMINIQUE DEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5151 N 9TH AVE, PENSACOLA, FL 32504-8721
(630) 689-1902
(630) 214-0017
Mailing address
5151 N 9TH AVE, PENSACOLA, FL 32504-8721
(630) 689-1902
(630) 214-0017
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922032424
MEDICARE
FL
05
—
1922032424
—
FL
Enumeration date
11/05/2014
Last updated
11/05/2014
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