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General NPI Number Information
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NPI Number | 1073409868
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Entity Type | Organization
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Legal Business Name | CYPRESS CROWN DERMATOLOGY PLLC
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 130 RIDGE CENTER DR STE 203
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City | DAVENPORT
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State | FL
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Zip | 33837-6416
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Country | US
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Telephone | 863-667-6647
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Fax | 312-276-8889
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Provider Business Mailing Address
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Address Line | 229 W LAKE SUMMIT DR
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City | WINTER HAVEN
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State | FL
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Zip | 33884-1528
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Country | US
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Telephone | 216-246-0269
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Fax | 312-276-8889
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA TUNG
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Credential | MD
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Telephone | 216-246-0269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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