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Theresa M Domagola, ACNP-BC,PMHNP-BC
Acute Care Nurse Practitioner in Jacksonville, Florida
NPI 1184676322

Theresa M Domagola is an Acute Care Nurse Practitioner based in Jacksonville, FL and is specialized in Acute Care. Theresa M Domagola practices in Jacksonville, FL and has the professional credentials of ACNP-BC,PMHNP-BC. The NPI Number for Theresa M Domagola is 1184676322 and holds a License No. 430210 (Florida).

The current practice location address for Theresa M Domagola is 15255 Max Leggett Pkwy Ste 3600, Jacksonville, FL and can be reached out via phone at 904-427-6895.

Location: 15255 Max Leggett Pkwy Ste 3600, Jacksonville, FL, 32218-7279
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Provider Profile Details
NPI Number
1184676322
Provider Name
Theresa M Domagola
Credential
ACNP-BC,PMHNP-BC
Provider Entity Type
Individual
Gender
Female
Address
15255 Max Leggett Pkwy Ste 3600, Jacksonville, FL, 32218-7279
Phone Number
904-427-6895
Fax Number
Provider Enumeration Date
05/16/2006
Last Update Date
07/20/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
70008ARA6884 01 MCR
02601196 05 NY
institution
Provider Business Practice Location Address Details
Address
15255 Max Leggett Pkwy Ste 3600
City
State
Zip
32218-7279
Phone Number
904-427-6895
Fax Number
person
Provider Business Mailing Address Details
Address
15255 Max Leggett Pkwy Ste 3600
City
State
Zip
32218-7279
Phone Number
904-427-6895
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Acute Care
Taxonomy
License No.
430210 (New York)
Definition
Definition to come...
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