IndividualActive
Carlo Domingo, AGNP-C
NPI 1194251272 · Gerontology Nurse Practitioner · Hainesville, IL
Provider details
- NPI number
- 1194251272
- Entity type
- Individual
- Primary specialty
- Gerontology Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- AGNP-C
- Sex
- Male
- Sole proprietor
- No
- License
- 209.019378 (IL)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
4 N Deer Point Dr
Ste 1002
Hainesville, IL 60030-3814
Phone: (847) 946-0198
Approximate (ZIP-level) locationGet directions
Mailing address
4 N Deer Point Dr.
Hainesville, IL 60030-3814
Registry dates
- Enumerated
- 2017-05-10
- Last updated
- 2021-10-11
- Certified
- 2021-10-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.