Individual
LISSETTE MARIA DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2625 TAMIAMI TRL, SUITE 5, PORT CHARLOTTE, FL 33952-6403
(941) 764-7999
Mailing address
2625 TAMIAMI TRL, SUITE 5, PORT CHARLOTTE, FL 33952-6403
(941) 764-7999
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP9248661
FL
Other
Enumeration date
01/17/2011
Last updated
01/17/2011
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