MEDICARE: BEACHES DERMATOLOGY, P.A.

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	174400000X	Specialist	207N00000X	FL

General Provider Information

NPI Number	:	1780627521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACHES DERMATOLOGY, P.A.

Provider Business Mailing Address
First Line	:	103 SOLANA RD
Second Line	:	SUITE B
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2231
Country	:	US
Telephone Number	:	904-273-2717
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 SOLANA RD
Second Line	:	SUITE B
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2231
Country	:	US
Telephone Number	:	904-273-2717
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLARENCE E BOUDREAUX
Credential	:	M.D.
Telephone Number	:	904-273-2717

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/10/2017

Similar Medicare Providers

1265149165 — CHELSEY GALLEGOS
Practice Location Address:

103 SOLANA RD
PONTE VEDRA BEACH, FL
32082-2231

Practice Phone: 904-273-2717
Practice Fax:

1689203341 — DR. BLAKE WILLIAM BOUDREAUX MD
Practice Location Address:

103 SOLANA RD STE B
PONTE VEDRA BEACH, FL
32082-2231

Practice Phone: 904-273-2717
Practice Fax:

1598723793 — MRS. JUDITH E BAIRD PA-C
Practice Location Address:

103 SOLANA RD , STE B
PONTE VEDRA BEACH, FL
32082-2231

Practice Phone: 904-273-2717
Practice Fax: 904-273-0410

1750514055 — MRS. HANNAH LOGIE SOMENSATTO ARNP
Practice Location Address:

103B SOLANA RD
PONTE VEDRA BEACH, FL
32082-2231

Practice Phone: 904-273-2717
Practice Fax: 904-273-0410

1639580236 — ANDREA DISTEFANO FNP-BC
Practice Location Address:

103 SOLANA RD , SUITE B
PONTE VEDRA BEACH, FL
32082-2231

Practice Phone: 904-273-2717
Practice Fax: 904-273-0410

1497420293 — MORGAN METZ
Practice Location Address:

103 SOLANA RD
PONTE VEDRA BEACH, FL
32082-2231

Practice Phone: 904-273-2717
Practice Fax:

Directions to “BEACHES DERMATOLOGY, P.A. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.