MEDICARE: TANIA LIZ ROSARIO DOMINGUEZ NP

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	11002763	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790345437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA LIZ ROSARIO DOMINGUEZ NP

Provider Business Mailing Address
First Line	:	9863 SW 184TH ST
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-6934
Country	:	US
Telephone Number	:	305-317-9592
Fax Number	:	786-431-2577

Provider Business Practice Location Address
First Line	:	9863 SW 184TH ST
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-6934
Country	:	US
Telephone Number	:	305-317-9592
Fax Number	:	786-431-2577

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

Provider Enumeration Date	:	06/15/2019
Last Update Date	:	02/17/2026

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