Healthcare Provider Details

I. General information

NPI: 1851916431
Provider Name (Legal Business Name): NICOLE ELISE DOMINACH DNP, APRN, AGPCNP-BP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE.
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 604
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-242-1300
  • Fax: 585-473-5007
Mailing address:
  • Phone: 585-275-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309643
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number771327-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: