Intracoastal Dermatology, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME110325 Issued in FL

Legal business name

INTRACOASTAL DERMATOLOGY, PLLC

Practice address

4776 Hodges Blvd Ste 105
Jacksonville, FL 32224-7218

Phone

(904) 655-5310

NPI assigned

Nov 1, 2012

Last updated

Jan 24, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kendall Adkisson, M.D.

Title

Manager

Phone

(904) 655-5310

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Melissa Singleton, PA-C

  • Physician Assistant
  • Ocala, FL
  • NPI 1164597399
  NPD

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

{
    "created_epoch": "1351728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642982400000",
    "number": "1194079988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4776 HODGES BLVD STE 105",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322247218",
            "telephone_number": "904-655-5310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4776 HODGES BLVD STE 105",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322247218",
            "telephone_number": "904-655-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTRACOASTAL DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-01",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A",
        "authorized_official_last_name": "ADKISSON",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-655-5310",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME110325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Internal Medicine Associates of Jacksonville P a
• Internal Medicine Associates of Jacksonville, Gary a. Decker, MD, PA
• Internal Medicine of Jacksonville
• Interpreting Services Group LLC (Interpreting Services Group of Florida)
• Interventional Pain Professionals of North Florida
• Investing Bricks LLC
• Blessing Inyang
• Alessandro Iovannitti
• Jennifer Iovanovici
• Deanna Iovino, LCSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.