Academic Alliance In Dermatology, PLLC
Dermatology in Plant City, FL. Organization (NPI-2).
NPI number1770150617
StatusActive
Last updated in NPPESSep 14, 2026
Details
- NPI
- 1770150617
- 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
1503 W Reynolds StPlant City, FL 33563-4733
Phone 813-514-4688 · Fax 813-341-3288
Mailing address
Po Box 23329New York, NY 10087-3329
Fax 410-883-0876
Authorized official
Nicole Proffitt
Director Of Enrollment & Credential
8048696269
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