South Tampa Dermatology PL

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME66332 Issued in FL

Legal business name

SOUTH TAMPA DERMATOLOGY PL

Practice address

2605 W Swann Ave
Suite #300
Tampa, FL 33609-4039

Phone

(813) 872-9551

Fax

(813) 872-9554

NPI assigned

Aug 22, 2006

Organization subpart

No

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

Authorized official

Name

Mr. James G Flynn

Title

Treasurer

Phone

(813) 872-9551

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Tampa Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 4

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

• Linda J Flynn, M.D.

  • Procedural Dermatology Physician
  • Tampa, FL
  • NPI 1194854679
  Medicare reassignment NPD
• Jessica M Hage, PA

  • Medical Physician Assistant
  • Tampa, FL
  • NPI 1649553587
  Medicare reassignment
• Dana Marie Hess, P.A.C.

  • Surgical Physician Assistant
  • Brandon, FL
  • NPI 1255562971
  Medicare reassignment
• Loralee Koontz, PA

  • Physician Assistant
  • Tampa, FL
  • NPI 1750490629
  NPD (past)

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467568477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2605 W SWANN AVE",
            "address_2": "SUITE #300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094039",
            "telephone_number": "813-872-9551",
            "fax_number": "813-872-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2605 W SWANN AVE",
            "address_2": "SUITE #300",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094039",
            "telephone_number": "813-872-9551",
            "fax_number": "813-872-9554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TAMPA DERMATOLOGY PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FLYNN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "813-872-9551",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME66332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "26291A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Tampa Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Tampa After Hours Clinic, LLC
• South Tampa Cardiology LLC
• South Tampa Counseling Associates
• South Tampa Dental
• South Tampa Dental Studio
• South Tampa Imaging Associates PA
• South Tampa Klynergy Massage & Wellness
• South Tampa Medical Associates Inc
• South Tampa Private Therapy, LLC
• South Tampa Psychiatry

• Specialist in Tampa, FL
• Providers in Tampa, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.