Healthcare Provider Details

I. General information

NPI: 1073381802
Provider Name (Legal Business Name): SKYLAKE MEDICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 NE MIAMI GARDENS DR STE. 280
N. MIAMI BEACH FL
33179-4758
US

IV. Provider business mailing address

1380 NE MIAMI GARDENS DR STE. 280
N. MIAMI BEACH FL
33179-4758
US

V. Phone/Fax

Practice location:
  • Phone: 818-267-4606
  • Fax: 305-749-6505
Mailing address:
  • Phone:
  • Fax: 305-749-6505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. LARISA TURETSKY
Title or Position: NURSE PRACTITIONER
Credential: ARNP
Phone: 305-735-2022