Organization · NPI-2

Academic Alliance In Dermatology, PLLC

Dermatology · Tampa, FL

NPI number1215504154

StatusActive

Last updated in NPPESSep 14, 2026

Details

NPI: 1215504154
Entity type: Organization (NPI-2)
Legal business name: Academic Alliance In Dermatology, PLLC
Organization subpart: Yes
Enumeration date: Jun 9, 2021
Certification date: Sep 14, 2026
Last updated: Sep 14, 2026

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207N00000X	Dermatology	–	–	Yes
207ND0101X	Dermatology, MOHS-Micrographic Surgery	–	–
207ND0900X	Dermatology, Dermatopathology	–	–
207NP0225X	Dermatology, Pediatric Dermatology	–	–
207NS0135X	Dermatology, Procedural Dermatology	–	–

Practice location

4700 N Habana Ave Ste 303
Tampa, FL 33614-7118

Phone 813-341-3285 · Fax 813-341-3284

Mailing address

Po Box 23329
New York, NY 10087-3329

Fax 410-873-0876

Authorized official

Nicole Proffitt
Director Of Enrollment & Credential
8048696269

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