Provider Demographics
NPI:1871977504
Name:POTENZA, DOMINICA M (DNP)
Entity type:Individual
Prefix:DR
First Name:DOMINICA
Middle Name:M
Last Name:POTENZA
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Gender:F
Credentials:DNP
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Mailing Address - Street 1:2800 BRUCKNER BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1369
Mailing Address - Country:US
Mailing Address - Phone:718-597-9595
Mailing Address - Fax:718-597-2807
Practice Address - Street 1:2800 BRUCKNER BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1369
Practice Address - Country:US
Practice Address - Phone:718-597-9595
Practice Address - Fax:718-597-2807
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2021-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY307408363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health