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NPI Code Detail

MEDICARE: DOMINIQUE SOPHIA DESTINY SPEAKS FNP

MEDICARE: DOMINIQUE SOPHIA DESTINY SPEAKS FNP
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
1363LF0000XFamily Nurse Practitioner19820SC

General Provider Information

NPI Number : 1235595141
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE SOPHIA DESTINY SPEAKS FNP
Provider Business Mailing Address
First Line : 360 N IRBY ST
Second Line :
City : FLORENCE
State : SC
Zip : 29501-2808
Country : US
Telephone Number : 843-667-9414
Fax Number : 843-667-1362
Provider Business Practice Location Address
First Line : 652 N MATTHEWS RD
Second Line :
City : LAKE CITY
State : SC
Zip : 29560-7008
Country : US
Telephone Number : 843-432-3677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2016
Last Update Date : 01/17/2023

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