Individual provider · Type 1 NPI
Theresa M. Domagola, ACNP-BC, PMHNP-BC
Acute Care Nurse Practitioner · Jacksonville, FL
NPI number
1184676322
Active
Practice location
15255 Max Leggett Pkwy Ste 3600
Jacksonville, FL 32218-7279
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 430210 (NY) |
| Acute Care Nurse Practitioner Primary | 363LA2100X | 11002747 (FL) |
Acute Care Nurse Practitioner: Definition to come...
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About NPI 1184676322
Theresa M. Domagola, ACNP-BC, PMHNP-BC's National Provider Identifier is 1184676322, issued on May 16, 2006. The primary taxonomy on file is Acute Care Nurse Practitioner (363LA2100X), and the practice location is in Jacksonville, FL. The record was last updated on Jun 24, 2024.