Individual
LISA MARY DOMINACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
2335 AARON ST, PORT CHARLOTTE, FL 33952-5305
(855) 979-5700
(855) 979-5701
Mailing address
3434 HANCOCK BRIDGE PKWY, STE 301, NORTH FORT MYERS, FL 33904-7094
(877) 856-3774
(239) 599-2612
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
26NJ00408700
NJ
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP9360998
FL
Other
Enumeration date
12/06/2012
Last updated
03/18/2016
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