MEDICARE: DERICK DERMATOLOGY, PLLC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1861159675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERICK DERMATOLOGY, PLLC

Provider Business Mailing Address
First Line	:	2590 HEALING WAY STE 220
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-5496
Country	:	US
Telephone Number	:	847-381-8899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2590 HEALING WAY STE 220
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-5496
Country	:	US
Telephone Number	:	847-381-8899
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. AMY JANE DERICK
Credential	:
Telephone Number	:	847-381-8899

Provider Enumeration Date	:	11/29/2021
Last Update Date	:	09/09/2022

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