Healthcare Provider Details

I. General information

NPI: 1710695408
Provider Name (Legal Business Name): DNP-DERM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 WALDEN WOODS DR # 4087
PLANT CITY FL
33566-7168
US

IV. Provider business mailing address

2501 WALDEN WOODS DR # 4087
PLANT CITY FL
33566-9998
US

V. Phone/Fax

Practice location:
  • Phone: 813-330-0106
  • Fax: 833-464-3525
Mailing address:
  • Phone: 813-330-0106
  • Fax: 833-464-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEISCHA N CASH
Title or Position: CEO & FOUNDER
Credential: DNP
Phone: 315-882-2967