Individual
KIMBERLY DOMIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
601 E ROLLINS ST, ORLANDO, FL 32803-1248
(407) 667-0444
(407) 667-4338
Mailing address
291 SOUTHHALL LN, MAITLAND, FL 32751-7274
(407) 667-0444
(407) 667-4338
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP3396392
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308172900
—
FL
01
—
G4190
BCBS
FL
Enumeration date
02/14/2007
Last updated
09/25/2014
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