Healthcare Provider Details

I. General information

NPI: 1811831084
Provider Name (Legal Business Name): DOMINIQUE FOSTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9738 COMMERCE CENTER CT
FORT MYERS FL
33908-3670
US

IV. Provider business mailing address

9738 COMMERCE CENTER CT
FORT MYERS FL
33908-3670
US

V. Phone/Fax

Practice location:
  • Phone: 239-308-4701
  • Fax:
Mailing address:
  • Phone: 239-308-4701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11046866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: