Provider Demographics
NPI:1477091262
Name:ADVANCED DERMAL SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:ADVANCED DERMAL SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-703-2534
Mailing Address - Street 1:6655 N CANYON CREST DR
Mailing Address - Street 2:APT 5123
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-0938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6655 N CANYON CREST DR
Practice Address - Street 2:APT 5123
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-0938
Practice Address - Country:US
Practice Address - Phone:520-730-2534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty