MEDICARE: JASMINE DOMINGO 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
1	363L00000X	Nurse Practitioner	850534	NV

General Provider Information

NPI Number	:	1508706995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE DOMINGO APRN

Provider Business Mailing Address
First Line	:	10470 W. CHEYENNE AVE. STE 115
Second Line	:	PMB 145
City	:	LAS VEGAS
State	:	NV
Zip	:	89129
Country	:	US
Telephone Number	:	808-445-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	10470 W. CHEYENNE AVE. STE 115
Second Line	:	PMB 145
City	:	LAS VEGAS
State	:	NV
Zip	:	89129
Country	:	US
Telephone Number	:	808-445-5879
Fax Number	:

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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