Leavitt Medical Associates of Florida Inc
Organization Active NPI Dermatology Physician · Heathrow, FL
NPI 1528097284 · NPPES record last updated Aug 29, 2017
Key facts
- NPI
- 1528097284
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- OS5365 (FL)
- Legal business name
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
- Practice address
- 120 International Pkwy
240
Heathrow, FL 32746-5031 - Phone
- (407) 333-4200
- Fax
- (407) 829-6637
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Amy Declue
- Title
- Director of Provider Services
- Phone
- (407) 875-2080
Corporate family (same tax ID) 22
Practitioners 196
-
Alice Gee-Su Beard, PA-C
-
Elise Christine Bjelica, ARNP
-
Annmarie Green Bolduc, APRN
-
Ruby Bush, PA-C
-
Nicole Christine Cabbad, M.D., M.B.A.
-
Devonne Collins, ARNP
-
Jessica Anne Dale, AGPCNP-BC
-
Alexander Dane, D.O.
-
Patrick L Dominguez, M.D.
-
Stephen W Eubanks, M.D.
-
Sophie Eusebio-Perea, ARNP
-
Maria E Garcia-Cardona, M.D.
-
Melissa A Hodges, APRN
-
Jahdonna Isaac, MD
-
Angela Marie Jones, MMS, PA-C
-
Mark D. Kaufmann, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0973519 | Advanced Dermatology & Cosmetic Surgery | Accreditation | Jun 23, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050228000737 | FL | Part B Supplier - Clinic/Group Practice | 4688579311 |
Receives reassigned benefits from 243 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Leavitt Medical Associates of Florida Inc
Locations (25 of 63)
220 N Westmonte Dr
Ste A
Altamonte Springs, FL 32714
Phone (407) 788-8900
2620 S Seacrest Blvd
Ste A
Boynton Beach, FL 33435
710 Oakfield Dr
Ste 154
Brandon, FL 33511
Phone (813) 651-1991
540 Medical Oaks Ave
Brandon, FL 33511
632 Del Prado Blvd N
Ste 20
Cape Coral, FL 33909
632 Del Prado Blvd N
Cape Coral, FL 33909
Phone (239) 343-3800
3251 N McMullen Booth Rd
Ste 202
Clearwater, FL 33761
Phone (727) 712-3455
2757 Citrus Tower Blvd
Ste 201
Clermont, FL 34711
1920 Don Wickham Dr
Ste 300
Clermont, FL 34711
Phone (352) 394-1650
2893 Enterprise Rd
Debary, FL 32713
6274 Linton Blvd
Ste 201
Delray Beach, FL 33484
2915 Lakeview Dr
Ste 2021
Fern Park, FL 32730
Phone (407) 788-8900
9191 R G Skinner Pkwy
Ste 202203
Jacksonville, FL 32256
7855 Argyle Forest Blvd
Ste 70
Jacksonville, FL 32244
1551 Riverside Ave
Jacksonville, FL 32204
4100 Southpoint Dr E
Ste 701
Jacksonville, FL 32216
7855 Argyle Forest Blvd
Ste 701
Jacksonville, FL 32244
Phone (904) 483-2277
222 Broadway
Unit 202
Kissimmee, FL 34741
Phone (407) 624-5808
903 N Central Ave
Kissimmee, FL 34741
Phone (407) 705-5100
120 International Pkwy
Ste 120
Lake Mary, FL 32746
202 Lake Miriam Dr
Ste 1
Lakeland, FL 33813
Phone (863) 647-2333
202 Lake Miriam Dr
Ste S1
Lakeland, FL 33813
Phone (863) 647-2333
202 Lake Miriam Dr
#1
Lakeland, FL 33813
151 Southhall Ln
Maitland, FL 32751
Phone (321) 270-6083
2600 Lake Lucien Dr
Maitland, FL 32751
Networks
- HealthSun Health Plans Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | OS5365 | FL | Yes |
| MOHS-Micrographic Surgery Physician |
207ND0101X | OS5365 | FL | |
| Dermatopathology Physician |
207ND0900X | OS5365 | FL | |
| Pediatric Dermatology Physician |
207NP0225X | OS5365 | FL | |
| Procedural Dermatology Physician |
207NS0135X | OS5365 | FL | |
| Family Medicine Physician |
207Q00000X | OS5365 | FL | |
| Allergy & Immunology (Internal Medicine) Physician |
207RA0201X | OS5365 | FL | |
| Plastic Surgery Physician |
208200000X | OS5365 | FL | |
| Surgery Physician |
208600000X | OS5365 | FL |
Addresses
Primary practice location
120 International Pkwy
240
Heathrow, FL 32746-5031
Mailing address
151 Southhall LN
Ste 300
Maitland, FL 32751-7233
Phone (407) 875-2080
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 256877200 | Medicaid | FL |
Other names
- Advanced Dermatology And Cosmetic Surgery
Other providers in Heathrow, FL
- Scott Allen Kirksey
- Grete Kofoed
- Natalie Kwong
- Marilyn Laughlin
- James Lawrence
- Lauren Leavitt
- Angela J Lee
- Donna Liegel
- Kenneth H Lucas
- Patrick Lupton
All providers in Heathrow, FL · Dermatology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.