NPIMap

Organization Active NPI

Academic Alliance in Dermatology, PLLC

  • Dermatology Physician
  • Tampa, FL
National Provider Identifier
1669049615
Registry record updated Sep 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ACADEMIC ALLIANCE IN DERMATOLOGY, PLLC
Practice address
13321 N 56TH St
Tampa, FL 33617-1161
Phone
(813) 341-1488
Fax
(813) 341-1489
NPI assigned
Jun 8, 2021
Last updated
Sep 14, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ACADEMIC ALLIANCE IN DERMATOLOGY, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 14, 2026

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

Authorized official

Name
Nicole Proffitt
Title
Director of Enrollment & Credential
Phone
(804) 869-6269

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU
Dermatopathology Physician 207ND0900X NU
Pediatric Dermatology Physician 207NP0225X NU
Procedural Dermatology Physician 207NS0135X NU

Addresses

Primary practice location

13321 N 56TH St
Tampa, FL 33617-1161

Mailing address

PO Box 23329
New York, NY 10087-3329

National Provider Directory

National Provider Directory
Tax ID family
Panos Vasiloudes MD21 organizations share this tax ID, including this one
Part of
Panos Vasiloudes MD

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789344000000",
    "number": "1669049615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23329",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873329",
            "fax_number": "410-883-0876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13321 N 56TH ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336171161",
            "telephone_number": "813-341-1488",
            "fax_number": "813-341-1489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMIC ALLIANCE IN DERMATOLOGY, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ACADEMIC ALLIANCE IN DERMATOLOGY, PLLC",
        "enumeration_date": "2021-06-08",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-14",
        "status": "A",
        "authorized_official_last_name": "PROFFITT",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR OF ENROLLMENT & CREDENTIAL",
        "authorized_official_telephone_number": "804-869-6269"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.