LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC (NPI# 1366672610) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366672610 |
| Entity Type | Organization |
| Organization Name | LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC |
| Other Organization Name | ADVANCED DERMATOLOGY |
| Practice Address |
14546 Old Saint Augustine Rd Suite 407 Jacksonville FL 32258-5468 |
| Mailing Address |
2600 Lake Lucien Dr Suite 180 Maitland FL 32751-7233 |
| Practice Telephone | 9044006565 |
| Mailing Telephone | 4078752080 |
| Mailing Fax Number | 4078750518 |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2009-07-21 |
| Authorized Official Name | NEFRITA LOGAN (PROVIDER SERVICE REP) |
| Authorized Official Telephone | 4078752080 |
| Is Organization Subpart | Y |
| Parent Organization Name | LMG |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
FL | Allopathic & Osteopathic Physicians | |
| Y | 207N00000X | Dermatology | FL | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Advanced Dermatology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992095681 | Leavitt Medical Associates of Florida Inc | Dermatology | 3427 Mariner Blvd, Spring Hill, FL 34609-2463 | 2011-04-14 |
| 1477708865 | Leavitt Medical Associates of Florida Inc | Dermatology | 3006 17th St, Saint Cloud, FL 34769-6011 | 2008-11-26 |
| 1952555674 | Leavitt Medical Associates of Florida Inc | Dermatology | 5041 Pine Island Rd Nw, Bokeelia, FL 33922-3269 | 2008-11-07 |
| 1275791758 | Leavitt Medical Associates of Florida Inc | Dermatology | 1816 Salk Ave, Tavares, FL 32778-4300 | 2008-05-30 |
| 1083872535 | Leavitt Medical Associates of Florida Inc | Dermatology | 484 Us Highway 1, Ste C, Sebastian, FL 32958-8497 | 2008-05-30 |
| 1407014996 | Leavitt Medical Associates of Florida Inc | Dermatology | 16100 Ne 16th Ave, North Miami Beach, FL 33162-4708 | 2008-05-30 |
| 1043478522 | Leavitt Medical Associates of Florida Inc | Dermatology | 2101 Us Highway 1, Jupiter, FL 33477-7321 | 2008-05-30 |
| 1710145271 | Leavitt Medical Associates of Florida Inc | Family Medicine | 260 Lookout Pl Ste 103, Maitland, FL 32751-4485 | 2008-05-30 |
| 1417115908 | Leavitt Medical Associates of Florida Inc | Dermatology | 910 Old Camp Rd Ste 166, The Villages, FL 32162-5604 | 2008-05-30 |
| 1427216936 | Leavitt Medical Associates of Florida Inc | Dermatology | 49 Royal Palm Pt Ste 100, Vero Beach, FL 32960-4270 | 2008-05-30 |
| Street Address |
14546 OLD SAINT AUGUSTINE RD SUITE 407 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32258-5468 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437154804 | Kyle G Corbin | Physical Therapist | 14546 Old Saint Augustine Rd, Suite 209, Jacksonville, FL 32258-5468 | 2005-06-14 |
| 1881208593 | Aaron Bailey | Registered Nurse | 14546 Old Saint Augustine Rd, Jacksonville, FL 32258-5468 | 2020-09-01 |
| 1801354675 | Morgen Rachel Fletcher | Physician Assistant | 14546 Old Saint Augustine Rd, Jacksonville, FL 32258-5468 | 2019-03-11 |
| 1467988246 | Fridah Kirimi | Nurse Practitioner | 14546 Old Saint Augustine Rd, Bldg 1 Suite 317, Jacksonville, FL 32258-5468 | 2017-05-11 |
| 1275901878 | Paul David Provenzano | Physical Therapist | 14546 Old Saint Augustine Rd, Jacksonville, FL 32258-5468 | 2015-09-14 |
| 1992188825 | Julianne Bryce | Physical Therapist | 14546 Old Saint Augustine Rd, Suite 209, Jacksonville, FL 32258-5468 | 2015-07-09 |
| 1174954630 | Ashley B Burton | Social Worker | 14546 Old Saint Augustine Rd, Bldg 1 Suite 317, Jacksonville, FL 32258-5468 | 2013-12-10 |
| 1376895888 | Cancer Specialists LLC | Durable Medical Equipment & Medical Supplies | 14546 Old Saint Augustine Rd, Bldg 1 Suite 317, Jacksonville, FL 32258-5468 | 2012-10-08 |
| 1245591114 | Amber Rose Schueler Whitehead | Massage Therapist | 14546 Old Saint Augustine Rd, Suite 403, Jacksonville, FL 32258-5468 | 2012-06-06 |
| 1790051845 | Baptist Cardiology, Inc. | Internal Medicine | 14546 Old Saint Augustine Rd, Suite 103, Jacksonville, FL 32258-5468 | 2012-03-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437794237 | Nicoleta Descalzo | Behavior Technician | 12724 Grand Bay Parkway West, Suite 410, Jacksonville, FL 32258 | 2019-11-15 |
| 1992275572 | William Lundgren | Nurse Anesthetist, Certified Registered | 3625 University Blvd South, Jacksonville, FL 32258 | 2018-11-27 |
| 1104301159 | Emergency Physicians Inc | Emergency Medicine | 14534 Old St Augustine Rd, Suite 3110, Jacksonville, FL 32258 | 2018-09-26 |
| 1679092886 | Palm Life Medical Associates Pa | Assisted Living Facility | 12494 Acosta Oaks Drive, Jacksonville, FL 32258 | 2017-09-19 |
| 1679013932 | Optometry Vision Care Pllc | Optometrist | 14866 Old St. Augustine Rd Unit 110, Jacksonville, FL 32258 | 2017-03-06 |
| 1467991950 | North Florida Vision Group Inc | Optometrist | 14866 Old St. Augustine Rd., Suite 110, Jacksonville, FL 32258 | 2017-02-16 |
| 1124576566 | Revolution Chiropractic LLC | Chiropractor | 14866 Old St Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-14 |
| 1396291936 | Robyn Reaves | Nurse Practitioner | 12361 Richards Glen Ct, Jacksonville, FL 32258 | 2016-09-01 |
| 1326595927 | Lauren Cost | Chiropractor | 14866 Old St. Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-01 |
| 1487991170 | Mark Steven Colosimo | Pharmacist | 13820 Old St Augustine Road, Jacksonville, FL 32258 | 2013-01-15 |
| Find all providers in zip 32258 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902291784 | Brandon Tyler Beal | Dermatology | 6817 Southpoint Pkwy Ste 101, Jacksonville, FL 32216-6285 | 2015-03-30 |
| 1194079988 | Intracoastal Dermatology, Pllc | Dermatology | 4776 Hodges Blvd Ste 105, Jacksonville, FL 32224-7218 | 2012-11-01 |
| 1780861781 | Jacksonville Skin Cancer Center, P.a. | Dermatology | 4465 Baymeadows Rd Ste 5, Jacksonville, FL 32217-4727 | 2008-01-22 |
| 1720272644 | John Morello | Dermatology | 13111 Atlantic Blvd., Ste 4, Jacksonville, FL 32225 | 2007-09-04 |
| 1982740775 | Michael Edward Lutz | Dermatology | 4465 Baymeadows Rd, Suite 5, Jacksonville, FL 32217 | 2007-01-29 |
| 1386757540 | Joy R Boyne | Dermatology | 6869 Belfort Oaks Pl, Jacksonville, FL 32216-6242 | 2006-08-15 |
| 1124063391 | Robert Alan Baker | Dermatology | 11701-32 San Jose Blvd, Suite 216, Jacksonville, FL 32223 | 2006-06-19 |
| 1770521163 | James W Trimble | Dermatology | 6890 Belfort Oaks Pl, Jacksonville, FL 32216-6241 | 2006-06-04 |
| 1497709778 | Daniel J Abraham | Dermatology | 215b Station St, Jacksonville, NC 28546-6304 | 2006-05-20 |
| 1124076492 | Michael A. Gromet | Dermatology | 10036 Scott Mill Rd, Jacksonville, FL 32257-5885 | 2006-05-05 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32258 |
Please comment or provide details below to improve the information on LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.