Provider Demographics
NPI:1154001980
Name:CLORIE, DOMINGA
Entity type:Individual
Prefix:
First Name:DOMINGA
Middle Name:
Last Name:CLORIE
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 1:3627 NORTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2856
Mailing Address - Country:US
Mailing Address - Phone:407-705-3185
Mailing Address - Fax:
Practice Address - Street 1:3627 NORTHWOODS DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2856
Practice Address - Country:US
Practice Address - Phone:407-705-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide