Laura B Destefano (NPI# 1003145087, PAC ID# 3678741972) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1003145087 |
| PAC ID by PECOS | 3678741972 |
| Professional Enrollment ID | I20110712000270 |
| Full Name | Laura B Destefano |
| Organization Legal Name | WATERS EDGE DERMATOLOGY LLC |
| Address |
2484 Caring Way Unit C Port Charlotte FL 33952-5306 |
| Phone Number | 9412352111 |
| Gender | F |
| Graduation Year | 2005 |
| Primary Specialty | DERMATOLOGY |
| Group Practice PAC ID | 6901893155 |
| Number of Group Practice Members | 68 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 163 N Brevard Ave, Arcadia, FL 34266-4403 | 8634916448 | WATERS EDGE DERMATOLOGY LLC |
| 2484 Caring Way, Unit C, Port Charlotte, FL 33952-5306 | 9412352111 | WATERS EDGE DERMATOLOGY LLC |
| Organization Legal Name | WATERS EDGE DERMATOLOGY LLC |
| Physicians | 65 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jonathan M Carp | Dermatology | Waters Edge Dermatology LLC | 6642 W Atlantic Ave, Delray Beach, FL 33446-1616 |
| Stefan Doig | Dermatology | Waters Edge Dermatology LLC | 2910 Se3rd Ct, Ocala, FL 34471-0485 |
| Christopher Spock | Dermatology | Waters Edge Dermatology LLC | 121 S State Rd, Suite 7, Wellington, FL 33414-4338 |
| Gioconda A Boaz | Physician Assistant | Waters Edge Dermatology LLC | 2685 Forest Hill Blvd, West Palm Beach, FL 33406-5930 |
| Claudia Alejandra Vera | Physician Assistant | Waters Edge Dermatology LLC | 562 N Us Hwy 27, Lady Lake, FL 32159-3776 |
| Shery M Varghese | Dermatology | Waters Edge Dermatology LLC | 590 Malabar Rd Se, Suite 2, Palm Bay, FL 32907-3108 |
| Michael T Siino | Physician Assistant | Waters Edge Dermatology LLC | 7605 Conroy Windermere Rd, Orlando, FL 32835-2646 |
| Theodore A Schiff | Dermatology | Waters Edge Dermatology LLC | 600 Village Square Xing, Palm Beach Gardens, FL 33410-4543 |
| John Gregory Neily | Dermatology | Waters Edge Dermatology LLC | 4315 Tamiami Trl S, Venice, FL 34293-5117 |
| Jodie Schmidt | Nurse Practitioner | Waters Edge Dermatology LLC | 22411 Hwy 27, Lake Wales, FL 33859-6861 |
| Street Address |
2484 CARING WAY UNIT C |
| City | PORT CHARLOTTE |
| State | FL |
| Zip | 33952-5306 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sidney Peykar | Cardiovascular Disease (cardiology) | Cardiac Arrhythmia Institute Pa | 2484 Caring Way, Unit B, Port Charlotte, FL 33952-5306 |
| Sydney Vanhoose | Nurse Practitioner | Waters Edge Dermatology LLC | 2484 Caring Way, Unit C, Port Charlotte, FL 33952-5306 |
| Nicole Brandon Higel-backes | Nurse Practitioner | Cardiac Arrhythmia Institute Pa | 2484 Caring Way, Unit B, Port Charlotte, FL 33952-5306 |
| Sukdai Mangru | Certified Nurse Midwife | Port Charlotte Hma Physician Management LLC | 2484 Caring Way, Unit D, Port Charlotte, FL 33952-5306 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Robert A Barrett | Clinical Social Worker | Manuel Gallego Md Pa | 3460 Depew Circle, Port Charlotte, FL 33952 |
| Manuel F Gallego | Psychiatry | Manuel Gallego Md Pa | 3460 Depew Circle, Port Charlotte, FL 33952 |
| Mason S Maulsby | Nurse Practitioner | Manuel Gallego Md Pa | 3460 Depew Circle, Port Charlotte, FL 33952 |
| Kimberly M Huggard | Nurse Practitioner | Millennium Physician Group LLC | 2450 Tamiami Trl, Suite A, Port Charlotte, FL 33952-3922 |
| Rita F De Palma | Nurse Practitioner | Millennium Physician Group LLC | 2450 Tamiami Trl, Suite A, Port Charlotte, FL 33952-3922 |
| David M Reilly | Family Medicine | Millennium Physician Group LLC | 2450 Tamiami Trl, Suite A, Port Charlotte, FL 33952-3922 |
| Ewa A Bialikiewicz | Family Medicine | Millennium Physician Group LLC | 2450 Tamiami Trl, Suite A, Port Charlotte, FL 33952-3922 |
| Gary B Jacobs | Family Medicine | Millennium Physician Group LLC | 2450 Tamiami Trl, Suite A, Port Charlotte, FL 33952-3922 |
| Douglas G Henricks | Internal Medicine | Millennium Physician Group LLC | 2450 Tamiami Trl, Suite A, Port Charlotte, FL 33952-3922 |
| Joseph Piccolo | Family Medicine | Millennium Physician Group LLC | 2450 Tamiami Trl, Suite A, Port Charlotte, FL 33952-3922 |
| Find all physicians in zip 33952 | |||
| City | PORT CHARLOTTE |
| Zip Code | 33952 |
| Specialty | DERMATOLOGY |
| City + Specialty | PORT CHARLOTTE + DERMATOLOGY |
Please comment or provide details below to improve the information on Laura B Destefano.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.