Healthcare Provider Details

I. General information

NPI: 1114814332
Provider Name (Legal Business Name): FLORIDA COMPREHENSIVE DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 NE 43RD PL
OCALA FL
34479-8899
US

IV. Provider business mailing address

3520 NE 43RD PL
OCALA FL
34479-8899
US

V. Phone/Fax

Practice location:
  • Phone: 352-738-7546
  • Fax: 352-739-7546
Mailing address:
  • Phone: 352-738-7546
  • Fax: 352-739-7546

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 Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: BROCK KREIENBRINK
Title or Position: OWNER
Credential: RN
Phone: 352-738-7546