Provider Demographics
NPI:1881940898
Name:FLORIDA SPECIALTY DERMATOLOGY CARE LLC
Entity type:Organization
Organization Name:FLORIDA SPECIALTY DERMATOLOGY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-275-9100
Mailing Address - Street 1:400 N TAMPA ST
Mailing Address - Street 2:SUITE: 1100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4719
Mailing Address - Country:US
Mailing Address - Phone:813-275-9100
Mailing Address - Fax:813-275-9201
Practice Address - Street 1:400 N TAMPA ST
Practice Address - Street 2:SUITE: 1100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4719
Practice Address - Country:US
Practice Address - Phone:813-275-9100
Practice Address - Fax:813-275-9201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN SPECIALTY DERMATOLOGY CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty