Healthcare Provider Details

I. General information

NPI: 1093628802
Provider Name (Legal Business Name): HEATHER DENISE DOMINGUEZ BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8441 JOHN SHARP PKWY
BRYAN TX
77807-3207
US

IV. Provider business mailing address

8441 JOHN SHARP PKWY
BRYAN TX
77807-3207
US

V. Phone/Fax

Practice location:
  • Phone: 979-933-8404
  • Fax:
Mailing address:
  • Phone: 979-933-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number755742
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: