Healthcare Provider Details

I. General information

NPI: 1437982055
Provider Name (Legal Business Name): KHROM MEDSPA & WELLNESS FL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12462 W ATLANTIC BLVD STE 1
CORAL SPRINGS FL
33071-4086
US

IV. Provider business mailing address

12462 W ATLANTIC BLVD STE 1
CORAL SPRINGS FL
33071-4086
US

V. Phone/Fax

Practice location:
  • Phone: 954-688-9677
  • Fax: 754-704-7285
Mailing address:
  • Phone: 954-688-9677
  • Fax: 754-704-7285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TATIANA KHROM
Title or Position: PRESIDENT
Credential: MD
Phone: 954-688-9677