Advantage Dermatology, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

ADVANTAGE DERMATOLOGY, PA

Practice address

1514 Nira St
Jacksonville, FL 32207-8652

Phone

(904) 387-4991

Fax

(904) 384-3613

NPI assigned

Jun 3, 2014

Last updated

Jun 19, 2024By 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. Oliver Angel Perez, MDNPI 1245432970

Title

Ceo

Phone

(904) 387-4991

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

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.

• Oliver Angel Perez, MD

  • Dermatology Physician
  • Jacksonville, FL
  • NPI 1245432970
  Medicare reassignment Care Compare group NPD Authorized official
• Joshua McDaniel, PA

  • Physician Assistant
  • Tallahassee, FL
  • NPI 1245999770
  Medicare reassignment Care Compare group
• Jacquelyn O'Donnell, PA-C

  • Physician Assistant
  • Indianapolis, IN
  • NPI 1518402767

  FL

  Medicare reassignment Care Compare group
• Sarah Amarillo, PA-C

  • Physician Assistant
  • Saint Johns, FL
  • NPI 1437867504
  Medicare reassignment
• Paola Cristina Bracho Gutierrez

  • Family Nurse Practitioner
  • Hialeah, FL
  • NPI 1386507150
  Medicare reassignment
• Jasminh Breanna Flanagan, ARNP

  • Adult Health Nurse Practitioner
  • Jacksonville, FL
  • NPI 1508745027
  Medicare reassignment
• Jackelin Hernandez Sanchez

  • Primary Care Nurse Practitioner
  • Jacksonville, FL
  • NPI 1730624289
  Medicare reassignment

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1255744793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 NIRA ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078652",
            "telephone_number": "904-387-4991",
            "fax_number": "904-384-3613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 NIRA ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078652",
            "telephone_number": "904-387-4991",
            "fax_number": "904-384-3613"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 3rd St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Neptune Beach",
            "state": "FL",
            "postal_code": "322665082",
            "country_code": "US",
            "telephone_number": "904-387-4991",
            "fax_number": "904-384-3613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANTAGE DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-03",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "OLIVER",
        "authorized_official_middle_name": "ANGEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-387-4991",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.