Precision Dermatology and Skin Surgery PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME76595 Issued in FL

Legal business name

PRECISION DERMATOLOGY AND SKIN SURGERY PA

Practice address

1550 Riverside Ave
Jacksonville, FL 32204-4161

Phone

(904) 613-3966

NPI assigned

Jun 16, 2014

Last updated

Jun 30, 2021By 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

Angie Hubbard

Title

Manager

Phone

(904) 716-5102

Specialties & licenses 2

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 11

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.

• Angela Yvette Armstrong, ARNP

  • Nurse Practitioner
  • Orange Park, FL
  • NPI 1831190081
  Medicare reassignment Care Compare group NPD
• Sally Austill Bardin, PA-C

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1184577694
  Medicare reassignment Care Compare group NPD
• Leonard A Shvartzman, MD

  • MOHS-Micrographic Surgery Physician
  • Jacksonville, FL
  • NPI 1417947961

  Dermatology

  Medicare reassignment Care Compare group NPD
• Julia England, PA-C

  • Physician Assistant
  • Clermont, FL
  • NPI 1194554923
  Medicare reassignment Care Compare group
• Kaitlyn Michelle Fagan, PA

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1043900590
  Medicare reassignment Care Compare group
• Kathryn Mary Mansueti

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1841965175
  Medicare reassignment Care Compare group
• Kalin Sawdo, PA

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1629865027
  Medicare reassignment Care Compare group
• Dreama Sue Jenkins-Pilcher, MD

  • Dermatology Physician
  • Jacksonville, FL
  • NPI 1891733341
  Medicare reassignment NPD
• Christina L Morgan, PA-C

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1770108318
  Medicare reassignment
• Kelsey Palhegyi, PA-C

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1093596090
  Medicare reassignment
• Morgan Crook

  • Physician Assistant
  • Jacksonville, FL
  • NPI 1265202477
  NPD

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

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625011200000",
    "number": "1336553619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 RIVERSIDE AVE STE A",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044162",
            "telephone_number": "904-923-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 RIVERSIDE AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044161",
            "telephone_number": "904-613-3966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRECISION DERMATOLOGY AND SKIN SURGERY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-16",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "HUBBARD",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "904-716-5102"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME76595",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 30, 2021; 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.