INTRACOASTAL DERMATOLOGY, PLLC (NPI# 1194079988) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194079988 |
| Entity Type | Organization |
| Organization Name | INTRACOASTAL DERMATOLOGY, PLLC |
| Practice Address |
4776 Hodges Blvd Ste 105 Jacksonville FL 32224-7218 |
| Practice Telephone | 9046555310 |
| Mailing Telephone | 9046555310 |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2012-11-01 |
| Authorized Official Name | DR. KENDALL ADKISSON (MANAGER) |
| Authorized Official Telephone | 9046555310 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | ME110325 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
4776 HODGES BLVD STE 105 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32224-7218 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356974372 | Noelle Parker | Specialist/Technologist | 1 Unf Drivve, Jacksonville, FL 32224 | 2020-02-18 |
| 1124685102 | Charcy Rene Stiller | Specialist/Technologist | 1 Unf Dr., Jacksonville, FL 32224 | 2019-05-24 |
| 1265097513 | Mayo Clinic Jacksonville | Ambulance | 13970 Zumbro Dr, Jacksonville, FL 32224 | 2019-05-02 |
| 1639681471 | Brigantti Anesthesia & Spine Care | Clinic/Center | 1361 13th Ave South Suite #210, Jacksonville, FL 32224 | 2017-11-02 |
| 1093240061 | Beric Emilio Berlioz | Anesthesiology | 4500 San Pablo Rd S # J, Jacksonville, FL 32224 | 2017-04-26 |
| 1609240746 | Matthew James Dailey | Nurse Anesthetist, Certified Registered | 2500 San Pablo Rd S, Jacksonville, FL 32224 | 2015-11-29 |
| 1003299603 | Upscale Personal Care Home | Assisted Living Facility | 4375 Autumn River Road, Jacksonville, FL 32224 | 2015-07-01 |
| 1629459375 | Bellanid Fonseca | Social Worker | 3694 Summerlin Ln E, Jacksonville, FL 32224 | 2015-06-17 |
| 1164840500 | Nicholas Scotto | Physical Therapist | 11555 Central Pkwy Ste 1104, Jacksonville, FL 32224 | 2014-04-02 |
| 1497093454 | Quicker Care Urgent Care | Point of Service | 13770 Beach Blvd., Unit # 4, Jacksonville, FL 32224 | 2013-01-27 |
| Find all providers in zip 32224 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902291784 | Brandon Tyler Beal | Dermatology | 6817 Southpoint Pkwy Ste 101, Jacksonville, FL 32216-6285 | 2015-03-30 |
| 1780861781 | Jacksonville Skin Cancer Center, P.a. | Dermatology | 4465 Baymeadows Rd Ste 5, Jacksonville, FL 32217-4727 | 2008-01-22 |
| 1720272644 | John Morello | Dermatology | 13111 Atlantic Blvd., Ste 4, Jacksonville, FL 32225 | 2007-09-04 |
| 1982740775 | Michael Edward Lutz | Dermatology | 4465 Baymeadows Rd, Suite 5, Jacksonville, FL 32217 | 2007-01-29 |
| 1386757540 | Joy R Boyne | Dermatology | 6869 Belfort Oaks Pl, Jacksonville, FL 32216-6242 | 2006-08-15 |
| 1124063391 | Robert Alan Baker | Dermatology | 11701-32 San Jose Blvd, Suite 216, Jacksonville, FL 32223 | 2006-06-19 |
| 1770521163 | James W Trimble | Dermatology | 6890 Belfort Oaks Pl, Jacksonville, FL 32216-6241 | 2006-06-04 |
| 1497709778 | Daniel J Abraham | Dermatology | 215b Station St, Jacksonville, NC 28546-6304 | 2006-05-20 |
| 1124076492 | Michael A. Gromet | Dermatology | 10036 Scott Mill Rd, Jacksonville, FL 32257-5885 | 2006-05-05 |
| 1023089182 | John Paul Kartsonis | Dermatology | 11512 Lake Mead Ave Unit 401, Jacksonville, FL 32256-9687 | 2006-01-27 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32224 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.