LUMINARY DERMATOLOGY, PA (NPI# 1851955983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851955983 |
| Entity Type | Organization |
| Organization Name | LUMINARY DERMATOLOGY, PA |
| Practice Address |
2101 61st St W Bradenton FL 34209-5528 |
| Mailing Address |
4411 Bee Ridge Rd Pmb 309 Sarasota FL 34233-2514 |
| Practice Telephone | 9419266553 |
| Mailing Telephone | 9419266553 |
| Mailing Fax Number | 9412968501 |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2020-10-08 |
| Authorized Official Name | MRS. JESSICA LYNN PHILLIPS (CEO) |
| Authorized Official Telephone | 9413024669 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208200000X | Plastic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208D00000X | General Practice | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 174400000X | Specialist | Other Service Providers | ||
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207VG0400X |
Obstetrics & Gynecology Specialization: Gynecology |
Allopathic & Osteopathic Physicians | ||
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | FLORIDA BLUE | B8XVQ | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 18669 Tamiami Trail, Suite A, North Port, FL 34287 | 9419266553 | 9412968501 |
| 315 75th St W, Bradenton, FL 342093201 | 9419266553 | 9412968501 |
| 3651 Cortez Rd W # 101, Bradenton, FL 342103167 | 9419266553 | 9412968501 |
| 4315 S Tamiami Trl, Venice, FL 342935117 | 9419266553 | |
| 544 Bay Isles Rd, Longboat Key, FL 342283129 | 9419266553 | 9412968501 |
| Street Address |
2101 61ST ST W |
| City | BRADENTON |
| State | FL |
| Zip Code | 34209-5528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710974340 | Joseph M Branconi | Internal Medicine | 2101 61st St W, Bradenton, FL 34209-5528 | 2005-09-29 |
| 1306820964 | Kimberly French | Nurse Practitioner | 2101 61st St W, Bradenton, FL 34209-5528 | 2005-12-06 |
| 1467449017 | Robert J Subbiondo | Internal Medicine | 2101 61st St W, Bradenton, FL 34209-5528 | 2005-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740828029 | Cairn Clinic, LLC | Massage Therapist | 4701 Manatee Ave. West, Bradenton, FL 34209 | 2019-12-17 |
| 1790341782 | Kyle James Van Benschoten | Physical Therapist | Casa Mora Rehabilitation, Bradenton, FL 34209 | 2019-05-15 |
| 1336679117 | Jennifer Rose Patterson | Nurse Practitioner | 7211 6th Ave Nw, Bradenton, FL 34209 | 2017-06-14 |
| 1972872604 | Manatee Diagnostic Center West | Radiology | 2211 60th St West, Bradenton, FL 34209 | 2011-12-27 |
| 1235406646 | Manatee Diagnostic Center,ltd | Radiology | 2301 60th Street Court West, Suite C, Bradenton, FL 34209 | 2011-11-30 |
| 1073830758 | Melissa Anderson | Occupational Therapy Assistant | 5203 12th Ave Drive West, Bradenton, FL 34209 | 2010-04-21 |
| 1205060993 | Margaret Ann Kirkland | Dentist | 2902 59th St. W., Suite V, Bradenton, FL 34209 | 2009-05-08 |
| 1477791028 | Anna Maria Chiropractic Pllc | Chiropractor | 7315 9th Ave N.w., Bradenton, FL 34209 | 2009-02-04 |
| 1174783393 | The Lombardo Home | Assisted Living Facility | 620 71st Street North West, Bradenton, FL 34209 | 2008-06-11 |
| 1407041072 | Allison Jean Kelly | Occupational Therapist | 5949 17th Avenue W, Bradenton, FL 34209 | 2007-09-07 |
| Find all providers in zip 34209 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922355957 | Florida Medical Specialists | Dermatology | 4351 Cortez Rd W, Suite 101, Bradenton, FL 34210 | 2012-08-09 |
| 1407146194 | Leavitt Medical Associates of Florida Inc | Dermatology | 2001 Manatee Ave E, Suite 101, Bradenton, FL 34208-1620 | 2011-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144827577 | Onspot-fl LLC. | Dermatology | 16461 Domestic Ave, Fort Myers, FL 33912-6008 | 2020-10-08 |
| 1942855150 | International Dermatology Research, Inc. | Dermatology | 8370 W Flagler St Ste 200, Miami, FL 33144-2038 | 2019-08-05 |
| 1154815546 | Forefront Dermatology, S.c. | Dermatology | 7720 Us Highway 98 W Ste 240, Miramar Beach, FL 32550-7232 | 2018-06-19 |
| 1437517802 | Total Vein and Skin LLC | Dermatology | 10383 Hagen Ranch Road, Ste 100, Boynton Beach, FL 33437-3732 | 2016-02-01 |
| 1861812851 | Anand Haryani | Dermatology | 8745 N Us Highway 1, Sebastian, FL 32958-7524 | 2014-04-17 |
| 1164841797 | Michael Montuno | Dermatology | 38135 Market Sq Ste 108, Zephyrhills, FL 33542-7505 | 2014-04-10 |
| 1861813719 | Hillcrest Dermatology and Plastic Surgery P.a. | Dermatology | 733 Highway 466, Lady Lake, FL 32159-6340 | 2013-12-19 |
| 1619232501 | Alliant Dermatology Pa | Dermatology | 8620 E County Road 466, The Villages, FL 32162-3670 | 2012-07-07 |
| 1114218328 | Leavitt Medical Assocaittes of Florida Inc | Dermatology | 1426 E Bloomindale Ave, Valrico, FL 33596 | 2011-04-21 |
| 1992095681 | Leavitt Medical Associates of Florida Inc | Dermatology | 3427 Mariner Blvd, Spring Hill, FL 34609-2463 | 2011-04-14 |
| Find all providers with the same taxonomy | ||||
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| 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.