Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 11015367 | FL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 11015367 | FL |
NPI | 1326704230 |
---|---|
Provider Name | Devin Diogenes Dominguez |
First Address | New Port Richey, FL 34654-2501 |
Second Address | Safety Harbor, FL 34695-6605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2021 |
Last Update Date | 11/02/2022 |