Provider Demographics
NPI:1164769675
Name:FLORIDA DERMCARE, INC.
Entity Type:Organization
Organization Name:FLORIDA DERMCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:TEUSCHER
Authorized Official - Last Name:BEARDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-C
Authorized Official - Phone:386-365-2046
Mailing Address - Street 1:204 NW EMPORIA GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-8516
Mailing Address - Country:US
Mailing Address - Phone:386-365-2046
Mailing Address - Fax:
Practice Address - Street 1:204 NW EMPORIA GLN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8516
Practice Address - Country:US
Practice Address - Phone:386-365-2046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty