Leavitt Medical Associates of Florida Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC

Doing business as

Advanced Dermatology and Cosmetic Surgery

Practice address

1920 Don Wickham Dr
Suite 330
Clermont, FL 34711-1918

Phone

(352) 241-4298

Fax

(352) 241-7620

NPI assigned

May 30, 2008

Organization subpart

Yes

Parent organization

LEAVITT MEDICAL ASSOCIATES OF FLORIDA INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Declue

Title

Director, Provider Services

Phone

(407) 875-2080

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Advanced Dermatology and Cosmetic Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Part of

Leavitt Medical Associates of Florida Inc

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Breen, PA-C

  • Medical Physician Assistant
  • Dunedin, FL
  • NPI 1851692800
  NPD
• Kara Lockcuff, PA-C

  • Medical Physician Assistant
  • Maitland, FL
  • NPI 1689448078
  NPD
• Deborah Mendoza, PA

  • Physician Assistant
  • Weston, FL
  • NPI 1467562843
  NPD
• Panagiotis Mitropoulos, DO

  • Dermatology Physician
  • Heathrow, FL
  • NPI 1538283502
  NPD
• Mandy Lynn Moore, ARNP

  • Nurse Practitioner
  • Clermont, FL
  • NPI 1396168118
  NPD
• Nicole Wharton

  • Physician Assistant
  • The Villages, FL
  • NPI 1093107641
  NPD
• Shaunte Wilks, PA-C

  • Physician Assistant
  • Orlando, FL
  • NPI 1477093706
  NPD
• Mirabella M. Muller, PA

  • Physician Assistant
  • Washington, DC
  • NPI 1497230320
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282694400000",
    "number": "1144488628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 LAKE LUCIEN DR STE 180",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517235",
            "telephone_number": "407-875-2080",
            "fax_number": "407-875-0518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 DON WICKHAM DR",
            "address_2": "SUITE 330",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347111918",
            "telephone_number": "352-241-4298",
            "fax_number": "352-241-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "enumeration_date": "2008-05-30",
        "last_updated": "2010-08-25",
        "status": "A",
        "authorized_official_last_name": "DECLUE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR, PROVIDER SERVICES",
        "authorized_official_telephone_number": "407-875-2080"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256877219",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology and Cosmetic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Teresa Layman, CRNA
• Maria Clara Lazaro Alves de Souza
• Margaline Lazarre, APRN
• Cindy Nguyen Le, M.D.
• Learning Leaps Behavioral Services
• Ana Leblanc, LMT
• Morrell Deon Lee Sr., MA
• Richard Thomas Lee, CRNA
• Wenchi Lee, A P
• Judith F Leeser, RD/LD/N/CDE

• Dermatology Physician in Clermont, FL
• Providers in Clermont, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.