Provider Demographics
NPI:1013891043
Name:HORAH-NANEZ, DOMINIQUE NICOLE
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:NICOLE
Last Name:HORAH-NANEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BHASKING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-3204
Mailing Address - Country:US
Mailing Address - Phone:203-820-0751
Mailing Address - Fax:
Practice Address - Street 1:240 INDIAN RIVER RD STE C7
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3691
Practice Address - Country:US
Practice Address - Phone:203-383-9846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14719363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health