Healthcare Provider Details

I. General information

NPI: 1083404396
Provider Name (Legal Business Name): ANTHONY VIRGILIO ROMANO DOMINGUEZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW 13TH ST
BOCA RATON FL
33486-2305
US

IV. Provider business mailing address

701 NW 13TH ST
BOCA RATON FL
33486-2305
US

V. Phone/Fax

Practice location:
  • Phone: 561-940-0538
  • Fax: 561-955-2730
Mailing address:
  • Phone: 561-940-0538
  • Fax: 561-955-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11047025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: