Healthcare Provider Details

I. General information

NPI: 1154127173
Provider Name (Legal Business Name): DERMATOLOGY GROUP OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5911 N HONORE AVE STE 210
SARASOTA FL
34243-2657
US

IV. Provider business mailing address

4000 HOLLYWOOD BLVD STE 215S
HOLLYWOOD FL
33021-1227
US

V. Phone/Fax

Practice location:
  • Phone: 941-308-7546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCY SEGUIN
Title or Position: VP OF RCM
Credential:
Phone: 954-237-7090