Healthcare Provider Details

I. General information

NPI: 1932029121
Provider Name (Legal Business Name): ADVANDERM CLINICAL MEDSPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2890 GRIFFIN RD STE 4
FORT LAUDERDALE FL
33312-5669
US

IV. Provider business mailing address

1612 SALERNO CIR
WESTON FL
33327-1904
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-9021
  • Fax: 954-708-1435
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RAMONA ANDERSON
Title or Position: OWNER/PROVIDER
Credential: APRN
Phone: 954-399-9021