MEDICARE: DERMATOLOGY ASSOCIATES OF CENTRAL FLORIDA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	ME66580	FL

General Provider Information

NPI Number	:	1194914390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY ASSOCIATES OF CENTRAL FLORIDA PA

Provider Business Mailing Address
First Line	:	3670 INNOVATION DRIVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33812-4105
Country	:	US
Telephone Number	:	863-686-2282
Fax Number	:	863-686-2370

Provider Business Practice Location Address
First Line	:	3670 INNOVATION DRIVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33812-4105
Country	:	US
Telephone Number	:	863-686-2282
Fax Number	:	863-686-2370

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID G YRASTORZA
Credential	:	MD
Telephone Number	:	863-686-2282

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	08/05/2025

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