Organization
LUMINARY DERMATOLOGY, PA
Active
Organization
LUMINARY DERMATOLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA LYNN PHILLIPS (CEO)
(941) 302-4669
Entity
Organization
Contact information
Practice address
2101 61ST ST W, BRADENTON, FL 34209-5528
(941) 926-6553
Mailing address
4411 BEE RIDGE RD, PMB 309, SARASOTA, FL 34233-2514
(941) 926-6553
(941) 296-8501
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
208200000X
Plastic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B8XVQ
FLORIDA BLUE
FL
Enumeration date
04/24/2019
Last updated
01/27/2025
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up