Gulfshore Dermatology at Coralwood, PA

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

ME74107 Issued in FL

Legal business name

GULFSHORE DERMATOLOGY AT CORALWOOD, PA

Practice address

326 Del Prado Blvd N Ste 301
Cape Coral, FL 33909-2288

Phone

(239) 458-1131

Fax

(239) 458-7789

NPI assigned

Jul 11, 2018

Last updated

Jul 11, 2018By 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

Mr. Andrew Leopold Smith

Title

Vice President

Phone

(239) 437-0562

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 6

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.

• Janet Flores Cheng, M.D.

  • Dermatology Physician
  • Cape Coral, FL
  • NPI 1275521478
  Medicare reassignment Care Compare group NPD
• Alyssa Thayer, APRN

  • Family Nurse Practitioner
  • Venice, FL
  • NPI 1447886585
  Medicare reassignment Care Compare group NPD
• Francesca Espinoza, PA-C

  • Medical Physician Assistant
  • Naples, FL
  • NPI 1326922386
  Medicare reassignment Care Compare group
• Christal L Dimarco, PA

  • Physician Assistant
  • Fort Myers, FL
  • NPI 1316249444
  Medicare reassignment
• Navya Miryala, PA-C

  • Physician Assistant
  • Cape Coral, FL
  • NPI 1013865468
  NPD
• Brianna Langford, PA-C

  • Dermatology Physician
  • Lake Worth, FL
  • NPI 1326861709
  NPD (past)

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

{
    "created_epoch": "1531267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531267200000",
    "number": "1376029579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 DEL PRADO BLVD N STE 301",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339092288",
            "telephone_number": "239-458-1131",
            "fax_number": "239-458-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 DEL PRADO BLVD N STE 301",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339092288",
            "telephone_number": "239-458-1131",
            "fax_number": "239-458-7789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULFSHORE DERMATOLOGY AT CORALWOOD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-11",
        "last_updated": "2018-07-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "LEOPOLD",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "239-437-0562",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "FL",
            "license": "ME74107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gulf Coast Pharmacy Consultants
• Gulf Coast Village Home Health (Home Health by Gulf Coast Village)
• Gulf Home Health, Inc
• Gulf Med Pharmacy Inc
• Gulfcoast Healthcare Group LLC
• Gulfside Living Healthcare Services, LLC
• Nisha Patel Gupta, PA-C
• Kristin Ann Gustin, APRN
• Yoandra Gutierrez Avila
• Yainy Gutierrez Mirabal

• Procedural Dermatology Physician in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Procedural Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; 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.