MEDICARE: ABRAHAM DOMINGUEZ-WILLIAMS

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	363LA2100X	Acute Care Nurse Practitioner	APRN11018143	FL

General Provider Information

NPI Number	:	1497402440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABRAHAM DOMINGUEZ-WILLIAMS

Provider Business Mailing Address
First Line	:	16930 TRADEWIND PT
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16930 TRADEWIND PT
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3255
Country	:	US
Telephone Number	:	646-455-7038
Fax Number	:

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

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	09/17/2025

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