Organization
STATE WIDE DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN Y HARRELL ARNP (OWNER)
(813) 749-6907
Entity
Organization
Contact information
Practice address
17121 RAINBOW TER, ODESSA, FL 33556-2107
(813) 749-6907
(813) 475-7831
Mailing address
17121 RAINBOW TER, ODESSA, FL 33556-2107
(813) 749-6907
(813) 475-7831
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
02/19/2014
Last updated
07/28/2014
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