Individual
AMERICA SEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3951 S NOVA RD, PORT ORANGE, FL 32127-9270
(386) 256-1444
Mailing address
3951 S NOVA RD, PORT ORANGE, FL 32127-9270
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
9116830
FL
Other
Enumeration date
12/21/2022
Last updated
12/21/2022
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