Organization
ATLANTIC DERM PLLC
Active
Organization
ATLANTIC DERM PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVETTE TIVOLI DO (OWNER)
(561) 802-7546
Entity
Organization
Contact information
Practice address
16244 S MILITARY TRL STE 490, DELRAY BEACH, FL 33484-6532
(561) 802-7546
Mailing address
16244 S MILITARY TRL STE 490, DELRAY BEACH, FL 33484-6532
(561) 802-7546
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS10758
MEDICAL LICENSE
FL
Enumeration date
12/03/2018
Last updated
12/03/2018
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