Healthcare Provider Details

I. General information

NPI: 1659564193
Provider Name (Legal Business Name): AMY SIMON ROSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2007
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S HOWARD AVE
TAMPA FL
33606-3491
US

IV. Provider business mailing address

4197 WOODLANDS PKWY
PALM HARBOR FL
34685-3493
US

V. Phone/Fax

Practice location:
  • Phone: 813-253-2635
  • Fax: 813-254-7241
Mailing address:
  • Phone: 813-333-1512
  • Fax: 813-333-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME100102
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME100102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: