Healthcare Provider Details

I. General information

NPI: 1851296941
Provider Name (Legal Business Name): LYDIA POLEY ELECTROLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7552 NAVARRE PARKWAY UNIT 62 3RD FLOOR
NAVARRE FL
32566
US

IV. Provider business mailing address

2439 CRESCENT RD
NAVARRE FL
32566-8790
US

V. Phone/Fax

Practice location:
  • Phone: 850-313-3115
  • Fax:
Mailing address:
  • Phone: 850-621-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE05913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: