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General NPI Number Information
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NPI Number | 1427712439
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Entity Type | Organization
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Legal Business Name | MY DERMATOLOGY & COSMETIC CENTER LLC
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Dates
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Enumeration Date | 10/26/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 818 CHESTNUT ST
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City | CLEARWATER
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State | FL
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Zip | 33756-5642
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Country | US
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Telephone | 727-295-7223
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Fax | 727-325-1060
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Provider Business Mailing Address
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Address Line | 818 CHESTNUT ST
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City | CLEARWATER
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State | FL
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Zip | 33756-5642
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Country | US
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Telephone | 727-295-7223
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Fax | 727-325-1060
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | HART MEYRICH
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Credential |
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Telephone | 407-340-9039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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