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General NPI Number Information
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NPI Number | 1942183132
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Entity Type | Organization
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Legal Business Name | BLUE OCEAN DERAMTOLOGY LLC
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 4110 US HIGHWAY 27 N
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City | SEBRING
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State | FL
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Zip | 33870-1335
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Country | US
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Telephone | 386-256-1444
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Fax | 321-400-1118
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Provider Business Mailing Address
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Address Line | 3951 S NOVA RD
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City | PORT ORANGE
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State | FL
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Zip | 32127-9270
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Country | US
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Telephone | 386-256-1444
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Fax | 321-400-1118
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Authorized Official
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Title or Position | CREDENTIALING
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Name | JANE MARIE HOLT
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Credential |
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Telephone | 386-256-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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