Provider Demographics
NPI:1073409868
Name:CYPRESS CROWN DERMATOLOGY PLLC
Entity type:Organization
Organization Name:CYPRESS CROWN DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-246-0269
Mailing Address - Street 1:229 W LAKE SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1528
Mailing Address - Country:US
Mailing Address - Phone:216-246-0269
Mailing Address - Fax:312-276-8889
Practice Address - Street 1:130 RIDGE CENTER DR STE 203
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6416
Practice Address - Country:US
Practice Address - Phone:863-667-6647
Practice Address - Fax:312-276-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty