Healthcare Provider Details

I. General information

NPI: 1144827577
Provider Name (Legal Business Name): ONSPOT-FL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13770 PLANTATION RD # 103
FORT MYERS FL
33912-4460
US

IV. Provider business mailing address

PO BOX 23168
NEW YORK NY
10087-0001
US

V. Phone/Fax

Practice location:
  • Phone: 941-444-0011
  • Fax: 603-242-1653
Mailing address:
  • Phone: 941-444-0011
  • Fax: 603-952-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DARYN MULLHOLAND
Title or Position: OSD CREDENTIALING
Credential: MBA
Phone: 727-647-1188