Healthcare Provider Details

I. General information

NPI: 1326704230
Provider Name (Legal Business Name): DEVIN DIOGENES DOMINGUEZ MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 FOREST AVE
NEW PORT RICHEY FL
34653-2612
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-724-6111
  • Fax:
Mailing address:
  • Phone: 727-532-0002
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11015367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: