Provider Demographics
NPI:1548725146
Name:REGISTER, DOMINIQUE (RN)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:REGISTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 TRADEWINDS TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-5851
Mailing Address - Country:US
Mailing Address - Phone:321-239-7606
Mailing Address - Fax:
Practice Address - Street 1:3207 TRADEWINDS TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-5851
Practice Address - Country:US
Practice Address - Phone:321-239-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9203116163W00000X
251F00000X, 253J00000X, 253Z00000X, 374U00000X, 376K00000X, 385H00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No163W00000XNursing Service ProvidersRegistered Nurse
No251F00000XAgenciesHome Infusion
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024196800Medicaid