Provider Demographics
NPI:1114814332
Name:FLORIDA COMPREHENSIVE DERMATOLOGY
Entity type:Organization
Organization Name:FLORIDA COMPREHENSIVE DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:KREIENBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-738-7546
Mailing Address - Street 1:3520 NE 43RD PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-8899
Mailing Address - Country:US
Mailing Address - Phone:352-738-7546
Mailing Address - Fax:352-739-7546
Practice Address - Street 1:3520 NE 43RD PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34479-8899
Practice Address - Country:US
Practice Address - Phone:352-738-7546
Practice Address - Fax:352-739-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty