Healthcare Provider Details

I. General information

NPI: 1952806531
Provider Name (Legal Business Name): PENELOPE KALLIS SKOPIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 SERANO WAY UNIT 101
NOKOMIS FL
34275-5241
US

IV. Provider business mailing address

409 SERANO WAY UNIT 101
NOKOMIS FL
34275-5241
US

V. Phone/Fax

Practice location:
  • Phone: 941-484-8222
  • Fax:
Mailing address:
  • Phone: 941-484-8222
  • Fax: 941-486-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036160030
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME162911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: