Organization
BLUE OCEAN DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NITRA H WELCH (CFO)
(386) 256-1444
Entity
Organization
Contact information
Practice address
3951 S NOVA RD, SUITE 3, PORT ORANGE, FL 32127
(386) 256-1444
Mailing address
3951 S NOVA RD, SUITE 3, PORT ORANGE, FL 32127-9270
(386) 256-1444
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008597300
—
FL
Enumeration date
02/22/2013
Last updated
08/18/2025
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