MEDICARE: MRS. JACQUELINE DOMINGUEZ ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9309553	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598135758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE DOMINGUEZ ARNP

Provider Business Mailing Address
First Line	:	7834 W 16TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-3254
Country	:	US
Telephone Number	:	786-449-4664
Fax Number	:

Provider Business Practice Location Address
First Line	:	15955 SW 96TH ST
Second Line	:	SUITE 200
City	:	MIAMI
State	:	FL
Zip	:	33196-1271
Country	:	US
Telephone Number	:	786-467-3140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	01/26/2016

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