Healthcare Provider Details

I. General information

NPI: 1073152088
Provider Name (Legal Business Name): MEIRA DERMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8839 BRYAN DAIRY RD STE 115
LARGO FL
33777-1207
US

IV. Provider business mailing address

8484 W GULF BLVD
TREASURE ISLAND FL
33706-3422
US

V. Phone/Fax

Practice location:
  • Phone: 727-777-6098
  • Fax: 727-888-6829
Mailing address:
  • Phone: 727-777-6098
  • Fax: 727-888-6829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HOLLY FRANCES POHLER
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential: ARNP
Phone: 727-777-6098