Healthcare Provider Details

I. General information

NPI: 1053079590
Provider Name (Legal Business Name): DOMENICA MARIELA RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 RESEARCH PKWY STE 300
ORLANDO FL
32826-3265
US

IV. Provider business mailing address

12201 RESEARCH PKWY STE 300
ORLANDO FL
32826-3265
US

V. Phone/Fax

Practice location:
  • Phone: 407-823-2744
  • Fax:
Mailing address:
  • Phone: 407-823-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11025227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: