MEDICARE: FLORIDA DERMCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164769675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DERMCARE, INC.

Provider Business Mailing Address
First Line	:	204 NW EMPORIA GLN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-8516
Country	:	US
Telephone Number	:	386-365-2046
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 NW EMPORIA GLN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-8516
Country	:	US
Telephone Number	:	386-365-2046
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH TEUSCHER BEARDSLEY
Credential	:	ARNP-C
Telephone Number	:	386-365-2046

Provider Enumeration Date	:	01/04/2013
Last Update Date	:	01/04/2013

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Directions to “FLORIDA DERMCARE, INC. ” Practice Location

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