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NPI Code Detail

MEDICARE: EDNA DOMINO APRN

MEDICARE: EDNA DOMINO APRN
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
1207X00000XOrthopaedic Surgery PhysicianARNP1649932FL
2363L00000XNurse PractitionerAPRN1649932FL

General Provider Information

NPI Number : 1225026941
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDNA DOMINO APRN
Provider Business Mailing Address
First Line : 3033 WINKLER AVE UNIT 100
Second Line :
City : FORT MYERS
State : FL
Zip : 33916-9523
Country : US
Telephone Number : 239-277-7070
Fax Number : 239-277-7071
Provider Business Practice Location Address
First Line : 3033 WINKLER AVE UNIT 100
Second Line :
City : FORT MYERS
State : FL
Zip : 33916-9523
Country : US
Telephone Number : 239-277-7070
Fax Number : 239-277-7071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 12/03/2018

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Directions to “ EDNA DOMINO APRN” Practice Location

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