Domagola, Theresa M

Domagola, Theresa M is an individual health care provider with primary practice located at 15255 Max Leggett Pkwy Ste 3600 , Jacksonville FL 32218-7279. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as her primary health care specialty. Domagola, Theresa M can be contacted via phone (904) 427-6895.

Contact Information

Primary practice address
15255 Max Leggett Pkwy Ste 3600 Jacksonville FL 32218-7279
Phone: (904) 427-6895
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 430210 New York
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 11002747 Florida

Profile Details

NPI number 1184676322
LBN Legal business name Domagola, Theresa M
Credentials ACNP-BC, PMHNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date May 16th, 2006
Last updated Jun 24th, 2024 - about 6 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184676322 NPPES
Other 70008ARA6884 MCR
MEDICAID 02601196 MCR

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