Healthcare Provider Details

I. General information

NPI: 1679416291
Provider Name (Legal Business Name): DOMINIQUE MICHELLE GIVENS DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 SAN JUAN AVE
JACKSONVILLE FL
32210-3357
US

IV. Provider business mailing address

4475 SAN JUAN AVE
JACKSONVILLE FL
32210-3357
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-0314
  • Fax: 904-387-5496
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11045449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: