MEDICARE: YUSIMI DOMINGUEZ HERNANDEZ ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9320756	FL
2	103K00000X	Behavior Analyst	BCBA12477452	FL

General Provider Information

NPI Number	:	1215383039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUSIMI DOMINGUEZ HERNANDEZ ARNP

Provider Business Mailing Address
First Line	:	4610 WEYMOUTH ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-2252
Country	:	US
Telephone Number	:	786-468-0397
Fax Number	:

Provider Business Practice Location Address
First Line	:	4610 WEYMOUTH ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-2252
Country	:	US
Telephone Number	:	786-468-0397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	03/26/2026

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